Revised November 2, 2020

AFMC will continue to update this document as new information is identified.  Please check back often to ensure you have the most up-to-date information.

This document was developed in collaboration with Dr. Randy Walker’s office and should be used for reference purposes only.

Please refer to the payer for confirmation of covered services.

Go directly to a payer

Medicare

Medicaid – Arkansas

Blue Cross Blue Shield – Arkansas

Ambetter/QualChoice – Arkansas

Aetna – Arkansas

Aetna Medicare Advantage

Cigna – Arkansas

UnitedHealthcare

Humana/TRICARE

Provider Type

Physicians
Nurse practitioners
Physician assistants
Nurse midwives
Certified nurse anesthetists
Clinical psychologists
Clinical social worker
Registered dietitians
Nutrition professionals

What is the Service?

A visit with a provider who uses real-time telecommunication systems between a provider and a patient (telecommunication must use audio and visual capabilities)

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

Common telehealth services include:

99201-99215 (office or other outpatient visits)
– 95 Modifier or CS Modifier**
– POS 02 OR the POS you would typically report for a face-to-face visit (i.e., POS 11)

G0425-G0427 (telehealth consultations, emergency department or initial inpatient)

G0406-G0408 (follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs)

For a complete list of covered telehealth services: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

Requirements

For new* or established patients

Interactive Telecommunications System – Telehealth services provided via a real-time audio-video

*To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency (coinsurance and deductible would generally apply; however, the HHS OIG is providing flexibility for health care providers to reduce or waive cost-sharing for telehealth visits paid by federal health care programs.)

**New guidance issued of 04/07/2020 – utilize CS modifier on applicable claim lines to identify the service as subject to the cost-sharing waiver for COVID-19 testing related services and should NOT charge Medicare patients any coinsurance and/or deductible

Provider Type

Physician and other qualified healthcare professionals (LCSW, clinical psychologist, PT, OT, speech-language pathologist)

What is the Service?

A brief (5-10 minutes) check-in with your practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed.
OR
A remote evaluation of recorded video and/or images submitted by a new or established patient.

Virtual check-ins can be conducted with a broader range of communication methods, unlike Medicare telehealth visits, which require audio and visual capabilities for real-time communication.

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

HCPCS code G2012
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

HCPCS code G2010
Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment.

CMS revised to include new and established patients

Requirements

For established or existing patients

– Patient must initiate
– Communication is not related to a medical visit within the previous 7 days or lead to a medical visit within the next 24 hours
– Patient must verbally consent to receive virtual check-in
– Virtual check-ins can be conducted with a broader range of communication methods (i.e., telephone, audio/video, secure text messaging, email, or use of patient portal)

*Coinsurance and deductible would generally apply; however, the HHS OIG is providing flexibility for health care providers to reduce or waive cost-sharing for telehealth visits paid by federal health care programs.

Provider Type

Physician or other qualified healthcare professional (Nurse practitioner)

What is the Service?

Online Digital Evaluation and Management

Non-face-to-face, patient-initiated communication between a patient and their provider through an online patient portal

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

99421 (5-10 minutes)
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes

99422 (11-20 minutes)
Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes

99423 (>21 minutes)
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

G2061* (5-10 minutes)
Qualified non-physician health care professional online assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes

G2062* (11-20 minutes)
Qualified non-physician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11–20 minutes

G2063* (>21 minutes)
Qualified non-physician qualified health care professional assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.

Requirements

– For established patients**
– Service needs to be initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation.
– Communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hour (or soonest appointment available).
– The patient must verbally consent to receive virtual check-in services.

**The Medicare coinsurance and deductible would generally apply to these services.

Provider Type

Qualified non-physician health care professional

What is the Service?

Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent or guardian

Not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment

HCPCS / CPT Code

Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10; 11-20; or 21-30 minutes of medical discussion

98966 (5-10 minutes)
98967 (11-20 minutes)
98968 (>21 minutes)
POS that would have been used had the service occurred in person
Modifier 95

Requirements

Requires telephone

Established patient, parent or guardian

Patient-initiated

Cannot be related to a medical visit within the previous 7 days or lead to a visit within 24 hours or soonest available appointment

5-10; 11-20; or 21-30 minutes of medical discussion

Provider Type

MD/ANP

What is the Service?

Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian

Not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment

HCPCS / CPT Code

Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10; 11-20; or 20-30 minutes of medical discussion.

99441 (5-10 minutes)
99442 (11-20 minutes)
99443 (20-30 minutes)
POS that would have been used had the service occurred in person
Modifier 95

Requirements

Requires telephone

New or established patient, parent or guardian

Not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment

Provider Type

MD/ANP

What is the Service?

Annual Wellness Visit, Includes a personalized Prevention Plan of Service (PPPS), first visit

– Covered only once, within 12 months of Part B enrollment
– Patient pays nothing

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

G0438
Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) first visit (review of medical and social health history, and preventive services education)

Requirements

Must include personalized prevention plan of services
– Must utilize either interactive audio and video or audio only telecommunication that permits real-time communication​ (4/30/2020)

Provider Type

MD/ANP

What is the Service?

Annual Wellness Visit, subsequent visit

*Covered once every 12 months
*Patient pays nothing

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

HCPCS code G0439
Annual Wellness Visit, includes a health risk assessment and personalized prevention plan of service (PPPS) subsequent visit

Requirements

Must include personalized prevention plan of services

Provider Type

MD/ANP  (if legally authorized and qualified to provide the services in the state in which they are furnished – CNMs/CNSs/PAs)

What is the Service?

Transitional Care Management Services with Moderate Complexity Decision Making

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

99495
Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)

Requirements

Within 14 days of discharge

May be provided via telehealth

Provider Type

MD/ANP/ (if legally authorized and qualified to provide the services in the State in which they are furnished – CNMs/CNSs/PAs)

What is the Service?

Transitional Care Management Services with High Medical Decision Making

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

99496
Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge)

Requirements

Within 7 days of discharge

May be provided via telehealth

Provider Type

MD/ANP

What is the Service?

Advanced Care Planning
(Can be done at the time of an Annual Wellness Visit)

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

99497
Advance Care Planning, first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate

99498
Advance Care Planning, additional 30 minutes

Requirements

– First 30 minutes
– Additional 30 minutes
(Note:  No place of service code limitations.)

May be provided via telehealth

Provider Type

MD/ANP

What is the Service?

Subsequent Nursing Facility Care Services

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

99307-99310
Subsequent nursing facility care, per day, for the evaluation and management of a patient,

Requirements

Frequency restrictions removed via CMS-1744-IFC

Provider should review code requirements for the inclusion of 2 of 3 key components and time spent at bedside and on the patient’s facility floor or unit.

Must use interactive audio and video telecommunications

Limitation of 1 telehealth visit every 30 days

​

Provider Type

CDE

What is the Service?

Diabetes Self-Management Training Services

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

HCPCS code G0108 -G0109
Individual and group diabetes self-management training services, with a minimum of 1 hour of in-person instruction furnished in the initial year training period to ensure effective injection training

Requirements

Minimum of 1 hour in-person instruction

May be completed via audio-only

Provider Type

LCSW

What is the Service?

Behavior Assessments & Intervention

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

96150 – 96154
Individual and group health and behavior assessment and intervention

Requirements

Provider Type

LCSW

What is the Service?

Individual Psychotherapy

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

90832
Individual psychotherapy

90833 w/E&M
Individual psychotherapy

90834
Individual psychotherapy

90836 w/E&M
Individual psychotherapy

90837
Individual psychotherapy

90838 w/E&M
Individual psychotherapy

Requirements

90832 (30 minutes)

90833 (30 minutes)

90834 (45 minutes)

90836 (45 minutes)

90837 (60 minutes)

90838 (60 minutes)

Provider Type

LCSW

What is the Service?

Psychotherapy for Crisis

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

90839
Psychotherapy for crisis

90840
Psychotherapy for crisis

Requirements

Life Threatening/Complex Patient is in High Distress

90839 (60 minutes)

90840 (additional 30 minutes)

Provider Type

CDE

What is the Service?

Individual and Group Medical Nutrition Therapy

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

HCPCS code G0270
Individual and group medical nutrition therapy

97802
Individual and group medical nutrition therapy

97803
Individual and group medical nutrition therapy

97804
Individual and group medical nutrition therapy

Requirements

Provider Type

CDE

What is the Service?

Intensive Behavioral Therapy for Cardiovascular Disease

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

HCPCS code G0446
Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes

Requirements

Annual, 15 minutes

Provider Type

CDE

What is the Service?

Behavioral Counseling for Obesity

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

HCPCS code G0447
Face-to-face behavioral counseling for obesity, 15 minutes

Requirements

15 minutes

May be completed via audio-only

Provider Type

– MD/ANP
– LCSW

What is the Service?

Smoking Cessation Counseling

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

99406
Smoking cessation services

99407
Smoking cessation services

Requirements

Provider Type

– MD/ANP
– LCSW

What is the Service?

Alcohol and/or Substance Abuse Counseling

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

HCPCS code G0396
Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services

HCPCS code G0397
Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services

Requirements

Structed Assessment & Intervention Services

May be completed via audio-only

Provider Type

– MD/ANP
– LCSW

What is the Service?

Annual Alcohol Misuse Screening

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

HCPCS code G0442
Annual alcohol misuse screening, 15 minutes

Requirements

15 minutes minimum

May be completed via audio-only

Provider Type

– MD/ANP
– LCSW

What is the Service?

Behavioral Counseling for Alcohol Misuse

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

HCPCS code G0443
Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes

Requirements

Face-to-face, 15 minutes

May be completed via audio-only

Provider Type

– MD/ANP
– LCSW

What is the Service?

Annual Depression Screening

*These services covered through the end of the Public Health Emergency (PHE)

HCPCS / CPT Code

HCPCS code G0444
Annual depression screening, 15 minutes

Requirements

15 minutes

May be completed via audio-only

Provider Type

Physician
APRN

What Is The Service?

Generally, a provider must have an established relationship with a patient before utilizing telemedicine to treat a patient. See Medicaid Provider Manual § 105.190. However, DMS has the authority to relax this requirement in case of an emergency. Pursuant to Executive Order 20-05 and as allowed under current Medicaid policy, DMS is lifting the requirement to have an established professional relationship before utilizing telemedicine for physicians.

See Medicaid Provider Manual § 105.190

HCPCS / CPT Code

– E&M Code AND
– “GT” Modifier AND
– Place of Service “02”

Medicaid: https://afmc.org/wp-content/uploads/2020/03/Memorandum-DMS-01-physician-telemedicine.pdf

Requirements

DMS has lifted the requirement to have an established professional relationship before utilizing telemedicine for physicians under the following conditions for the duration of the emergency declaration:

– The physician providing telehealth services must have access to a patient’s personal health record maintained by a physician.
– The telemedicine service may be provided by any technology deemed appropriate, including telephone, but it must be provided in real time (cannot be delayed communication).
– Physicians may use telemedicine to diagnose, treat, and, when clinically appropriate, prescribe a non-controlled drug to the patient.

See Medicaid Provider Manual § 105.190

Provider Type

Clinician who can bill primary care services

What is the Service?

Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report E&M services, provided to an established patient, not originating from a related E&M service provided within the previous 7 days nor leading to an E&M service or procedure within the next 24 hours or soonest available appointment. Typically, 5-10 minutes of medical discussion.

See Medicaid Provider Manual § 105.190

HCPCS / CPT Code

G2012
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report E&M services, provided to an established patient, not originating from a related E&M service provided within the previous 7 days nor leading to an E&M service or procedure within the next 24 hours or soonest available appointment. Typically, 5-10 minutes of medical discussion.

*Code will be turned on April 1, 2020, and will be retroactive to date of service March 18, 2020

*Medicaid is opening the virtual check-in for 60 days. The code can be extended as required to address the public health emergency.

Requirements

The physician providing telehealth services must have access to a patient’s personal health record maintained by a physician.

The telemedicine service may be provided by any technology deemed appropriate, including telephone, but it must be provided in real time (cannot be delayed communication).

Physicians may use telemedicine to diagnose, treat, and, when clinically appropriate, prescribe a non-controlled drug to the patient.

Can be any real-time audio (telephone), or “2-way audio interactions that are enhanced with video or other kinds of data transmission.”

Available for established patients only

To be used for:
– Any chronic patient who needs to be assessed as to whether an office visit is needed.
– Patients being treated for opioid and other substance-use disorders.

Nurse or other staff member cannot provide this service. It must be a clinician who can bill primary care services.

If an E&M service is provided within the defined time frames, then the telehealth visit is bundled with that E&M service. It would be considered pre- or post-visit time and not separately billable.

No geographic location restrictions for the patient.

Communication must be HIPAA compliant.

Medicaid is opening the virtual check-in for 60 days. The code can be extended as required to address the public health emergency

See Medicaid Provider Manual § 105.190

Provider Type

– Licensed Psychologists
– Licensed Professional Counselor
– (LPC) Licensed Associate Counselors (LACs)
– Licensed Associate Marriage and Family Therapists (LAMFTs)
– Licensed Clinical Social Workers (LCSWs)
– Licensed Master Social Worker ( LMSWs)

What is the Service?

Continuation of critical services provided to established patients while they remain in their homes.

– The rule related to originating site requirements is suspended for 30 days.

– The suspension may be extended for additional 30-day periods throughout the declaration of emergency.

HCPCS / CPT Code

– Place of Service “02”

– Individual Behavioral Health Counseling

90832, U4, GT
Individual psychotherapy

90834, U4, GT
Individual psychotherapy

90837, U4, GT
Individual psychotherapy

– Psychoeducation

H2027, U4, GT

3/18/2020 – The rule will be suspended for 30 days. The suspension may be extended for additional 30-day periods throughout the declaration of emergency.

Behavioral Health: https://afmc.org/wp-content/uploads/2020/03/MEMORANDUM-DMS-02-OBH-telehealth.pdf

Requirements

DMS has suspended the rule related to originating site requirements for certain behavioral health providers to provide certain counseling services. By suspending this rule, these licensed behavioral health professionals will be able to continue to provide critical services to established patients while they remain in their homes.

– Must be established patient

– Any technology deemed appropriate may be used, including telephones, but technology must utilize direct communication that takes place in real-time

– Diagnostic services cannot be provided when the beneficiary is not in a separate originating provider facility

Provider Type

MD/ANP/DO/PA

What is the Service?

The health care professional at the distant site must submit claims for telemedicine services using HCPCS or CPT Code for the professional service delivered, along with telemedicine modifier GT via interactive audio and video telecommunications systems or 95 synchronous telemedicine services rendered via real time interactive audio and video telecommunications

HCPCS / CPT Code

99201 or
99202 or
99203 or
99204 or
99211 or
99212 or
99213 or
99214

AND

GT modifier or
95 modifier or
CS Modifier*

AND

POS 02

Requirements

Telemedicine or telephonic communication may be used to establish a relationship with provider and maintain the relationship

For additional coverage information:
– Review payers website information
– Review Telehealth policy

Requirements noted under current Telehealth Policy 2015034: https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2015034#lblCpt

Provider Type

In-network behavioral health professionals
Psychologist
LCSW
Licensed Professional Counselors.

What is the Service?

Arkansas Blue Cross Blue Shield and Health Advantage will provide payment for any in-network provider to visit by telephone with patients who are seeking advice or counsel on either physical or mental health needs.

In addition to creating this entirely new, temporary benefit for our fully insured members, Arkansas Blue Cross Blue Shield and Health Advantage will also waive all co-pays, coinsurance and deductibles for these new telephone-based benefits.

HCPCS / CPT Code

POS 02 or POS 11 or POS 12

99441 Telephone; 5-10 minutes
Telephone evaluation and management service by a qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

99442 Telephone; 11-20 minutes
Telephone evaluation and management service by a qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.

99443 Telephone; 21-30 minutes
Telephone evaluation and management service by a qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion.

Requirements

For additional coverage information:
– Review payers website information
– Review Telehealth policy

See Arkansas BCBS June 2020 Providers’ News for COVID-19 Updates  LINK HERE

Provider Type

MD/ANP

What is the Service?

A communication between a patient and their provider through an online patient portal.

HCPCS / CPT Code

99421 (5-10 minutes) over 7 days
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5 10 minutes

99422 (11-20 minutes) over 7 days
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11 20 minutes

99423 (<21 minutes) over 7 days
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

Requirements

**Must have POS code 02

For additional coverage information:
– Review payers website information
– Review Telehealth policy

Requirements noted under current Telehealth Policy 2015034: https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2015034#lblCpt

See Arkansas BCBS June 2020 Providers’ News for COVID-19 Updates  LINK HERE

Provider Type

MD/APRN

What is the Service?

Telehealth services are effective for the duration of the COVID-19 emergency

A visit with a provider that uses telecommunication systems between a provider and a patient

Established patient unless seen by a referral healthcare professional or an on-call healthcare professional, or in an emergency situation where the life or health of the patient is in danger

Any services that can be delivered virtually will be eligible for telehealth coverage.

HCPCS / CPT Code

99201-99205
99211-99215
G2010 and G2012

AND

POS 02
Modifier 95 or GT

Requirements

Testing waived for COVID-19 (diagnostic testing or medical screening) when medically necessary and ordered and/or referred by licensed healthcare provider. Members’ copayment, coinsurance and/or deductible cost-sharing will be waived for testing and/or medical care, along with the associated physician’s visit.    

– Fully insured group plan will cover the cost of treatment and the associated doctor’s visit.
– Self-funded plans refer to Plan Administrator for COVID-19 coverage questions.

QualChoice- see medical policy B1529.  For additional clarification contact your QualChoice Provider Relations Representative.

Provider Type

Qualified healthcare professional

What Is The Service?

Telephone-only services have historically not been covered but will now be covered through January 21, 2021. For more information regarding telephone-only visits, please see medical policy BI063.

HCPCS / CPT Code

Telephonic services (99441-99443) will be covered through October 23, 2020

Requirements

For additional clarification contact your QualChoice Provider Relations Representative.

Provider Type

MD/ANP

What is the Service?

A visit with a provider who uses telecommunication systems between a provider and a patient

HCPCS / CPT Code

99201-99205
99211-99215

Requirements

Requires an audiovisual connection or telephone

Testing waived for COVID-19

Telemedicine claims (commercial) must use POS 02 with the GT or 95 modifier will reimburse the same as in-office visit 99213

Telemedicine Coverage Policy Liberalization (extended to 12/31/2020) for Commercial Plans

Provider Type

Non-physician Health Care Professional

What is the Service?

Qualified non-physician health care professional online assessment, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes; 11 – 20 minutes; or 21 or more minutes

Qualified non-physician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10; 11-20; or 21 or more minutes

HCPCS / CPT Code

Qualified non-physician health care professional online assessment, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes; 11 – 20 minutes; or 21 or more minutes
G2061 (5-10 minutes)
G2062 (11-20 minutes)
G2063 (>21 minutes)

Qualified non-physician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10; 11-20; or 21 or more minutes
98970 (5-10 minutes)
98971 (11-20 minutes)
98972 (>21 minutes)

Requirements

Requires audiovisual connection.

Minor Acute Evaluations will be covered via telephone for general medicine and behavioral health a synchronous audiovisual connection needed.

Aetna members are encouraged to use telemedicine to limit potential exposure in physician offices.

Cost sharing will be waived for all virtual visits through the Aetna-covered Teladoc® offerings and in-network providers.

Self-insured plan sponsors will be able to opt-out of this program at their discretion.

Provider Type

Non-physician Health Care Professional

What is the Service?

Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent or guardian

Not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment

HCPCS / CPT Code

Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10; 11-20; or 21-30 minutes of medical discussion
98966 (5-10 minutes)
98967 (11-20 minutes)
98968 (>21 minutes)

Requirements

Requires an audiovisual connection or telephone

Established patient, parent or guardian

Cannot be related to a medical visit within the previous 7 days or lead to a visit within 24 hours or soonest available appointment

5-10; 11-20; or 21-30 minutes of medical discussion

For the next 90 days Aetna will cover minor acute evaluation and management services care services rendered via telephone. A visual connection is not required. For general medicine and behavioral health visits – a synchronous audiovisual connection is still required. Aetna’s telemedicine policy is available to providers on the NaviNet and Availity portals.

Provider Type

Physician or other qualified health care professional who may report E&M services

What is the Service?

Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian

Not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment

HCPCS / CPT Code

Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10; 11-20; or 20-30 minutes of medical discussion.
99441 (5-10 minutes)
99442 (11 – 20 minutes)
99443 (20 – 30 minutes)

Requirements

Requires telephone

Established patient, parent or guardian

Not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment

Physician may provide care from any location

For the next 90 days Aetna will cover minor acute evaluation and management services care services rendered via telephone. A visual connection is not required. For general medicine and behavioral health visits – a synchronous audiovisual connection is still required. Aetna’s telemedicine policy is available to providers on the NaviNet and Availity portals.

Provider Type

MD/ANP

What Is The Service?

Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment.

Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

HCPCS / CPT Code

HCPCS code G2010
Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment.

HCPCS code G2012
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

Requirements

Requires an audiovisual connection or telephone

Cannot be related to a medical visit within the previous 7 days or lead to a visit within 24 hours

Coinsurance and deductible apply

Physician may provide care from any location

Provider Type

MD/ANP

What is the Service?

A communication between a patient and their provider through an online patient portal

HCPCS / CPT Code

Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10; 11-20; or 21 or more minutes.

99421 (5-10 minutes)
99422 (11-20 minutes)
99423 (>21 minutes)

Requirements

Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10; 11-20; or 21 or more minutes.

– For established patients

– Requires audiovisual connection

*Communication with Patient via portal – patient must initiate

– Cost sharing will be waived for all virtual visits through the Aetna-covered Teladoc® offerings and in-network providers.

– Self-insured plan sponsors will be able to opt-out of this program at their discretion.

Provider Type

LCSW

What is the Service?

Specific details for these services can be found at https://www.aetna.com/health-care-professionals/provider-education-manuals/covid-faq/billing-and-coding.html

HCPCS / CPT Code

Requirements

Provider Type

MD/ANP

What is the Service?

A visit with a provider that uses telecommunication systems between a provider and a patient

HCPCS / CPT Code

99201-99205
99211-99215

Requirements

For Medicare members, POS 02 or POS 11, or the POS equal to what it would have been, had the service been furnished in-person, along with the 95 modifier indicating that the service rendered was actually performed via telehealth, may be utilized and will reimburse at the same rate. (10/14/2020)
Cost shares are waived for in-network primary care and specialist telehealth visits through 1/31/2021.

Provider Type

MD/ANP

What is the Service?

A communication between a patient and their provider through an online patient portal

HCPCS / CPT Code

G2061 (5-10 minutes)
G2062 (11-20 minutes)
G2063 (>21 minutes)

Requirements

For established patients

Communication with patient via portal – patient must initiate

Through 9/30/2020, Aetna will offer zero co-pay telemedicine visits for any reason to all Individual and Group Medicare Advantage members. Aetna Medicare Advantage members should use telemedicine as their first line of defense to limit potential exposure in physician offices. Cost sharing will be waived for all Teladoc^® virtual visits. Cost sharing will also be waived for real-time virtual visits offered by in-network providers (live video conferencing or telephone-only telemedicine services). Medicare Advantage members may use telemedicine for any reason, not just COVID-19 diagnosis.

Provider Type

In-Network Qualified Licensed Healthcare Provider

What is the Service?

Quick telephonic consultation related to COVID-19 screening and/or other necessary consults and will offer appropriate reimbursement to providers for this amount of time

HCPCS / CPT Code

HCPCS G2012
Phone calls for COVID-19 or other necessary consults (e.g.: 5-10 minute virtual visit with or without video with the licensed health care provider)

Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5- 10 minutes of medical discussion

Requirements

Established patient

No co-pay

With or without video

Cost-share will be waived through April 20, 2021

Provider Type

In-Network Qualified Licensed Healthcare Provider (Physicians, Mid-Level Practitioners)

What is the Service?

Real-time, synchronous virtual visit

Related to COVID-19

HCPCS / CPT Code

Usual face-to-face E/M code – 99202 – 99215
– Modifier CR on CMS 1500 claims or Condition code DR on UB04 claims
– Append with GQ modifier for virtual care

Requirements

Cost share will be waived through April 20, 2021

Provider Type

In-Network Qualified Licensed Healthcare Provider (Physicians, Mid-Level Practitioners)

What is the Service?

Real-time, synchronous virtual visit

Confirmed COVID-19 Case

HCPCS / CPT Code

Usual face-to-face E/M code
– Append with GQ modifier for virtual care*

*Note: contradictory guidance in “Cigna Coronavirus (COVID-19) Interim Billing Guidance for Providers” states on page 4 item e. “No virtual care modifier should be billed”.

Requirements

Effective on dates of service on and after February 4, 2020

Cost-share will be waived only when providers bill the appropriate ICD10 code (U07.1, 82, M35.81 or M35.89)

Note that billing B97.29 will no longer waive cost-share. Effective August 1, 2020, U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnoses

Cost share is waived through February 15, 2021

Provider Type

In-Network Qualified Licensed Healthcare Provider (Physicians, Mid-Level Practitioners)

What is the Service?

Real time, synchronous

HCPCS / CPT Code

Usual face-to-face E/M code – 99202–99215
– Append with GQ modifier for virtual care
– POS normally billed**

**Billing a POS 02 or GT/95 modifier for virtual services may result in reduced payment or denied claims due to current system limitations. While we understand CMS guidance is to bill for a POS 02 for virtual care services, billing a typical place of service (POS 11) will ensure providers receive the same reimbursement as they typically get for a face-to-face visit.

Requirements

Services must be interactive and use both audio and video internet-based technologies (synchronous) to be reimbursed at the face-to-face rate

Cigna will reimburse usual face-to-face rates

Additional information can be found through the Virtual Care Reimbursement Policy

Provider Type

Qualified Providers

What Is The Service?

Telephone evaluation and management service provided by a physician or other qualified healthcare professional who may report E/M services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days or leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

HCPCS / CPT Code

99441 – 99443

Requirements

Established patient

Provider Type

Physician or other Qualified Healthcare Provider

What is the Service?

These services are for established patients, not related to a medical visit within the previous 7 days and not resulting in a medical visit within the next 24 hours (or soonest appointment available) using online patient portal

HCPCS / CPT Code

Established patients may have non-face-to-face, patient-initiated communications with their doctors, without going to the doctor’s office, by using online patient portals.

Physician, ANP, PA:
99421 (5-10 minutes)
99422 (11-20 minutes)
99423 (>21 minutes)

Place of Service: 11, 20 22, 23

Requirements

Use of online patient portal

Established patient

Patient must generate initial inquiry

Communication can occur over a seven-day period

Patient must verbally consent to receive virtual check-in services

Use appropriate Place of Service (11, 20, 22, 23)

No modifiers are required for commercial, Medicare Advantage or (UHC) Medicaid

The benefits describe federal requirements and UnitedHealthcare national policy. Additional benefits may be available in some states and under some plans.

Review the “Summary of COVID-19 Dates by Program” document for a quick reference guide to the beginning and ending dates of temporary program, process or procedure changes implemented by payer because of COVID-19. ¥

Medicaid:  State regulations will apply ¥

Review  the  Telehealth provider coding guidance for additional information and updates §

Provider Type

Physician or Qualified Health Care Professional

What is the Service?

Virtual check-in, by a Physician or Other Qualified Health Care Professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment – using audio-only technology

HCPCS / CPT Code

G2012 or G2252
These virtual check-ins are for patients with an established (or existing) relationship with a physician or certain practitioners, where the communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours (or soonest appointment available).

5-10 minutes of medical discussion

Requirements

Use appropriate Place of Service (11, 20, 22, 23)

Established patient

5-10 minutes of medical discussion

Furnished through communication technology modalities such as telephone

The patient must verbally consent to receive virtual check-in services

The benefits describe federal requirements and UnitedHealthcare national policy. Additional benefits may be available in some states and under some plans

Review the “Summary of COVID-19 Dates by Program” document for a quick reference guide to the beginning and ending dates of temporary program, process or procedure changes implemented by payer because of COVID-19. ¥

Medicaid:  State regulations will apply ¥

​Review  the  Telehealth provider coding guidance for additional information and updates §

Provider Type

In-network physician, nurse practitioner or physician assistant

What is the Service?

New or Established patient visit using HIPAA compliant or non-HIPAA compliant audio-video technology for COVID-19 or non-COVID-19 care.

HCPCS / CPT Code

New Patient:

• E/M Code: 99202 – 99205

Established Patient:

• E/M Code: 99211 – 99215
• Appropriate POS:
  • Medicare: 11, 20, 22, 23
  • Commercial and Medicaid: 02
• Modifier:
  • Medicare: 95
  • Commercial and Medicaid: Not required

Requirements

These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits

Telehealth services provided via the use of HIPAA-compliant or non-HIPAA-compliant audio-video or audio-only technology, such as FaceTime or Skype*

For new or established patients

Review the “Summary of COVID-19 Dates by Program” document for a quick reference guide to the beginning and ending dates of temporary program, process or procedure changes implemented by payer because of COVID-19. ¥

Review  the  Telehealth provider coding guidance for additional information and updates §

Medicaid:  State regulations will apply ¥

Provider Type

MD/ANP/PA

What is the Service?

Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days

HCPCS / CPT Code

G2010
Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days

Requirements

For established patients

No modifiers required for commercial, Medicare Advantage or UHC Medicaid

Use appropriate Place of Service code (11, 20, 22, 23)

Cannot be related to a medical visit within the previous 7 days or lead to a visit within 24 hours

Furnished through captured video or image

The patient must verbally consent to receive virtual check-in services

Review the “Summary of COVID-19 Dates by Program” document for a quick reference guide to the beginning and ending dates of temporary program, process or procedure changes implemented by payer because of COVID-19. ¥

Medicaid:  State regulations will apply ¥

Review  the  Telehealth provider coding guidance for additional information and updates §

Provider Type

MD/ANP

What is the Service?

A visit with a provider who uses telecommunication systems between a provider and a patient

HCPCS / CPT Code

99201-99205

99211-99215

• POS that would have been reported if furnished in person
• Modifier 95

Requirements

For additional information refer to: 2021 Medicare Advantage: COVID-19 Telehealth and Other Virtual Services Policy Updated: January 8, 2021

Provider Type

Physician

What Is The Service?

Online digital evaluation and management non-face-to-face communication through an online patient portal.

HCPCS / CPT Code

Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 5-10 minutes; 11-20 minutes; 21 or more minutes.

– 99421 – 99423

Bill with proper code utilizing POS as the medical office and modifier according to CMS Guidance, state-specific rules and Humana policy.

Requirements

Services for established patient.

Service initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation.

Communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours.

The patient must verbally consent to receive services

For additional information refer to: 2021 Medicare Advantage: COVID-19 Telehealth and Other Virtual Services Policy Updated: January 8, 2021

Provider Type

Qualified health care professional

What Is The Service?

Non-face-to-face telephone services: Telephone evaluation and management service by a physician or other qualified health care professional

HCPCS / CPT Code

Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes; 11-20 minutes; 21-30 minutes of medical discussion

– 99441-99443

Bill with proper code utilizing POS as the medical office and modifier according to CMS Guidance, state-specific rules and Humana policy.

Requirements

Services for established patient

Service provided via telephone

Communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours.

See payer details for cost-sharing information.

For additional information refer to: 2021 Medicare Advantage: COVID-19 Telehealth and Other Virtual Services Policy Updated: January 8, 2021

Provider Type

Physician or other qualified health care professional

What Is The Service?

Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional.

HCPCS / CPT Code

Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional.

Virtual Check-in use HCPCS: G2012

Requirements

Services for new or established patient

Patient must initiate

Communication is not related to a medical visit within the previous 7 days or lead to a medical visit within the next 24 hours

Patient must verbally consent to receive virtual check-in

See payer details for cost-sharing information

For additional information refer to: 2021 Medicare Advantage: COVID-19 Telehealth and Other Virtual Services Policy Updated: January 8, 2021