Telehealth Crosswalk
Revised July 10, 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
Blue Cross Blue Shield – Arkansas
Download the condensed Telehealth Crosswalk PDF
Medicare
Revised July 10, 2020
Medicare Telehealth Frequently Asked Questions (FAQs) – March 17, 2020
MLN Booklet – Telehealth Services – March 2020
Medicare Telehealth Benefit Video – Updated May 8, 2020: Medicare Coverage and Payment of Virtual Services
CMS COVID-19 FAQs on Medicare Fee-for-Service (FFS) Billing – Updated June 19, 2020
Medicare Telehealth Visits
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 under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video capabilities) between a provider and a patient. Effective for 90 days.
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
Special Instructions
POS 02 OR POS you would typically report for a face-to-face visit (i.e., POS 11)
Modifier 95
Virtual Check-in
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 under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video capabilities) between a provider and a patient. Effective for 90 days.
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.
Special Instructions
e-Visit
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 under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video capabilities) between a provider and a patient. Effective for 90 days.
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.
Special Instructions
*Clinicians who may not independently bill for evaluation and management visits (physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can utilize the G-codes to provide these e-visits and bill.
Telephone 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)
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
Special Instructions
Telephone Only Services
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
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
Special Instructions
Annual Wellness Visit, first visit
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 under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
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)
Special Instructions
Should include all required aspects of the visit.
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Annual Wellness Visit
Provider Type
MD/ANP
What is the Service?
Annual Wellness Visit, subsequent visit
*Covered once every 12 months
*Patient pays nothing
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
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
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Transitional Care Management
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 under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video capabilities) between a provider and a patient. Effective for 90 days.
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
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Transitional Care Management
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 under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video capabilities) between a provider and a patient. Effective for 90 days.
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
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Advanced Care Planning
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 under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
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
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Nursing Facility Visits
Provider Type
MD/ANP
What is the Service?
Subsequent Nursing Facility Care Services
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video capabilities) between a provider and a patient. Effective for 90 days.
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
Special Instructions
Telehealth DSM Training
Provider Type
CDE
What is the Service?
Diabetes Self-Management Training Services
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
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
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Behavior Assessment
Provider Type
LCSW
What is the Service?
Behavior Assessments & Intervention
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video capabilities) between a provider and a patient. Effective for 90 days.
HCPCS / CPT Code
96150 – 96154
Individual and group health and behavior assessment and intervention
Requirements
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Individual Psychotherapy
Provider Type
LCSW
What is the Service?
Individual Psychotherapy
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
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)
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Psychotherapy for Crisis
Provider Type
LCSW
What is the Service?
Psychotherapy for Crisis
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
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)
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Individual & Group MNT
Provider Type
CDE
What is the Service?
Individual and Group Medical Nutrition Therapy
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
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
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Behavioral Therapy for Cardiovascular Disease
Provider Type
CDE
What is the Service?
Intensive Behavioral Therapy for Cardiovascular Disease
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
HCPCS / CPT Code
HCPCS code G0446
Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
Requirements
Annual, 15 minutes
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Behavioral Counseling for Obesity
Provider Type
CDE
What is the Service?
Behavioral Counseling for Obesity
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
HCPCS / CPT Code
HCPCS code G0447
Face-to-face behavioral counseling for obesity, 15 minutes
Requirements
15 minutes
May be completed via audio-only
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Smoking Cessation Services
Provider Type
– MD/ANP
– LCSW
What is the Service?
Smoking Cessation Counseling
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
HCPCS / CPT Code
99406
Smoking cessation services
99407
Smoking cessation services
Requirements
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Alcohol and/or Substance Abuse Services
Provider Type
– MD/ANP
– LCSW
What is the Service?
Alcohol and/or Substance Abuse Counseling
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
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
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Annual Alcohol Misuse Screening
Provider Type
– MD/ANP
– LCSW
What is the Service?
Annual Alcohol Misuse Screening
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
HCPCS / CPT Code
HCPCS code G0442
Annual alcohol misuse screening, 15 minutes
Requirements
15 minutes minimum
May be completed via audio-only
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Behavioral Counseling for Alcohol Misuse
Provider Type
– MD/ANP
– LCSW
What is the Service?
Behavioral Counseling for Alcohol Misuse
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
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
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Telehealth Annual Depression Screening
Provider Type
– MD/ANP
– LCSW
What is the Service?
Annual Depression Screening
*These services covered under the 1135 waiver for telehealth when visit with a provider uses real-time telecommunication systems (with audio and video or audio only capabilities) between a provider and a patient. Effective for 90 days.
HCPCS / CPT Code
HCPCS code G0444
Annual depression screening, 15 minutes
Requirements
15 minutes
May be completed via audio-only
Special Instructions
Additional Information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
Medicaid
Revised July 10, 2020
Telemedicine
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.
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.
Special Instructions
Include:
– E&M Code
– GT Modifier
– POS 02
Virtual Check-in
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.
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
Special Instructions
Clinician who can bill primary care services
Telemedicine for Certain Behavioral Health Providers
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
Special Instructions
Arkansas Blue Cross Blue Shield and Health Advantage
(Verify Self-Funded Coverage with Payer)
Updated July 10, 2020
Existing Telehealth Policy 2015034
Updated June 5, 2020
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
Waiver of co-pays, coinsurance and deductibles
Self-Funded Plans – verify coverage with payer
Fully Insured Members: The temporary COVID-19 benefits put into place by Arkansas Blue Cross and Health Advantage will be extended to align with the federal mandated COVID-19 coverage provisions as specified in the FFCRA and CARES Act. The federal mandate currently runs through July 25, 2020
Self-Funded Plans: Decisions about coverage changes for members of self-funded health plans served by BlueAdvantage Administrators of Arkansas or Health Advantage are made by the employers or plan sponsors who fund those self-funded programs. If you have questions about your coverage, please call the number on the back of your card.
NOTE: 99205 & 99215 not covered services provided by telemedicine
Requirements noted under current Telehealth Policy 2015034: https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2015034#lblCpt
We are providing access to an in-network, statewide panel of almost 2,300 behavioral health professionals already credentialed and ready to serve their emotional/mental health needs via virtual access
See Arkansas BCBS June 2020 Providers’ News for COVID-19 Updates LINK HERE
Special Instructions
99205 & 99215 not covered services provided by telemedicine
Claim must include E&M code AND modifier AND POS 02
*Any COVID-19 evaluation visit should include “CS” modifier. Visit may include the following screenings:
– 87635-COVID19 (RT-PCR test)
– 87804- Influenza
– 86710– Influenza
– 87880- Streptococcus
Telephone-based Visit
Updated June 5, 2020
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.
(Services valid 3/16/2020 – 5/15/2020)
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
Established patient, parent or guardian
Pre-existing exclusions suspended. Verify coverage timeframe of either Fully Insured or Self-Funded updates.
Service provided by telephone
Usual member costs (co-pays, coinsurance and deductibles) are temporarily being waived for telemedicine visits with in-network physicians (MDs, DOs), advance practice nurse practitioners and physician assistants. This includes wellness/preventative visits.
Does not apply to self-funded plans
See Arkansas BCBS June 2020 Providers’ News for COVID-19 Updates LINK HERE
Special Instructions
E/M code and POS 02 or 11 or 12
Existing Telehealth Policy 2015034 for Behavioral Health
Updated June 5, 2020
Provider Type
LCSW
What is the Service?
HCPCS / CPT Code
90832
Psychotherapy, 30 minutes with patient
90833 w/E&M
Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (list separately in addition to the code for primary procedure)
90834
Psychotherapy, 45 minutes with patient
90836 w/E&M
Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (list separately in addition to the code for primary procedure)
90837
Psychotherapy, 60 minutes with patient
90838 w/E&M
Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)
Requirements
Requirements noted under current Telehealth Policy 2015034: https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2015034#lblCpt
We are extending this new, temporary insurance benefit for counseling by in-network behavioral health professionals. Specifically, we will pay for telemedicine counseling to our fully insured members by any in-network psychiatrist, clinical psychologist, advance practice nurse practitioner, licensed clinical social worker or licensed professional counselor. Copays, coinsurance and deductibles for these services are being waived at this time.
See Arkansas BCBS June 2020 Providers’ News for COVID-19 Updates LINK HERE
Special Instructions
Existing Telehealth Policy 2015034 for Behavioral Health
Provider Type
LCSW
What is the Service?
Behavioral Health Assessment & Intervention
HCPCS / CPT Code
96150
Health and behavior assessment (eg, health focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face to face with the patient; initial assessment
96151
Health and behavior assessment (eg, health focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face to face with the patient; re-assessment
96152
Health and behavior intervention, each 15 minutes, face to face; individual
Requirements
Requirements noted under current Telehealth Policy 2015034: https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2015034#lblCpt
We are extending this new, temporary insurance benefit for counseling by in-network behavioral health professionals. Specifically, we will pay for telemedicine counseling to our fully insured members by any in-network psychiatrist, clinical psychologist, advance practice nurse practitioner, licensed clinical social worker or licensed professional counselor. Copays, coinsurance and deductibles for these services are being waived at this time.
Special Instructions
Telehealth Smoking Cessation Services
Provider Type
MD/ANP
LCSW
What is the Service?
Smoking Cessation Counseling
HCPCS / CPT Code
99406
Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407
Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
Requirements
Requirements noted under current Telehealth Policy 2015034: https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2015034#lblCpt
Special Instructions
Telehealth Alcohol and/or Substance Abuse Services
Provider Type
MD/ANP
LCSW
What is the Service?
Alcohol and/or Substance Abuse Counseling
HCPCS / CPT Code
99408
Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes
99409
Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes
Requirements
Requirements noted under current Telehealth Policy 2015034: https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2015034#lblCpt
Special Instructions
Online Digital Evaluation & Management Services
Updated June 5, 2020
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
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
Special Instructions
Transitional Care Management
Provider Type
MD/ANP
What is the Service?
Transitional Care Management Services with Moderate Complexity Decision Making
HCPCS / CPT Code
99495
Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period face-to-face visit, within 14 calendar days of discharge
Requirements
Within 14 days of discharge
Requirements noted under current Telehealth Policy 2015034: https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2015034#lblCpt
Special Instructions
Transitional Care Management
Provider Type
MD/ANP
What is the Service?
Transitional Care Management Services with High Medical Decision Making
HCPCS / CPT Code
99496
Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of high complexity during the service period face-to-face visit, within 7 calendar days of discharge
Requirements
Within 7 days of discharge
Requirements noted under current Telehealth Policy 2015034: https://secure.arkansasbluecross.com/members/report.aspx?policyNumber=2015034#lblCpt
Special Instructions
Wellness Visits
Provider Type
MD/DO/ANP
What Is The Service?
Wellness Visits
HCPCS / CPT Code
99381 – 99397
POS- 02
Modifier GT or 95
Requirements
Appropriate documentation commensurate with the level of service provided and submitted for payment is to be placed in the medical record.
See Arkansas BCBS June 2020 Providers’ News for COVID-19 Updates – See Page 8 – LINK HERE
Special Instructions
Ambetter/QualChoice
Revised July 10, 2020
Telehealth Services During COVID-19 Outbreak – March 23, 2020
Telemedicine Payment Policy
Provider Type
MD/APRN
What is the Service?
Effective 03/16/2020 through 06/30/2020
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
Providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state
– POS 02
– Modifier 95 or GT
Copays, coinsurance and deductibles waived for all telemedicine services in-network telemedicine services from 03/17/2020 through 06/30/2020. NOTE: Out-of-network providers may balance bill the member.
Reimbursement for telemedicine services requires one time submission of signed Telemedicine Attestation form by the provider. This must also be accepted and approved by QualChoice. (This requirement is waived from 3/16/2020 – 6/30/2020 when many members will likely self-quarantine to prevent spread of COVID-19.)
QualChoice- see medical policy B1529. For additional clarification contact your QualChoice Provider Relations Representative.
Special Instructions
Non Face-To-Face Services: Telephonic Only
Provider Type
Qualified healthcare professional
What Is The Service?
Telephone-only services have historically not been covered but will now be covered through June 30, 2020. For more information regarding telephone-only visits, please see medical policy BI063.
Any services that can be delivered virtually will be eligible for telehealth coverage.
HCPCS / CPT Code
Telephonic services (99441-99443) will be covered temporarily (3/15/2020 – 6/30/2020) during the COVID-19 pandemic as a means of facilitating medical interactions without face-to-face encounters.
Requirements
Special Instructions
Aetna Commercial
Updated July 10, 2020
COVID-19: Billing and coding FAQs – Updated July 10, 2020
COVID-19: Telemedicine FAQs – Updated July 10, 2020
Existing Telemedicine Policy
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
No cost to patients for telemedicine visits through 12/31/2020
Special Instructions
Aetna is extending all member cost-sharing waivers for covered in-network telemedicine visits for outpatient and mental health counseling services for their commercial plans through 9/30/2020
Self-insured plans offer this waiver at their own discretion
Online Assessment
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.
Special Instructions
Services valid: 03/17/2020–09/04/2020
Telephone Assessment & Management
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.
Special Instructions
Telemedicine Policy extended through 8/04/2020
Telephone Assessment & Management
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.
Special Instructions
Virtual Check-in
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
Special Instructions
Medicare Advantage plans, effective 5/13/2020 through 12/31/2020 Aetna is waiving member out-of-pocket costs for all in-network primary care visits, whether done in-office and via telehealth, for any reason, and encourages members to continue seeking essential preventive and primary care during the crisis.
Online Digital E&M – e-Visit
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.
Special Instructions
Behavioral Health and Opioid Treatment
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
Special Instructions
Aetna Medicare Advantage
Updated July 10, 2020
COVID-19: Telemedicine FAQs – Updated July 10, 2020
e-Visit
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.
Special Instructions
E-Visit
Medicare Advantage plans, effective 5/13/2020 through 12/31/2020 Aetna is waiving member out-of-pocket costs for all in-network primary care visits, whether done in-office and via telehealth, for any reason, and encourages members to continue seeking essential preventive and primary care during the crisis.
Cigna
Updated July 10, 2020
Commercial: Medicare Telemedicine Health Care Provider Fact Sheet
Commercial – Updated June 23, 2020: Medicare Telehealth Frequently Asked Questions (FAQs)
Virtual Check-in (Telephone Consult)
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
Applies to services submitted on CMS1500 claims or electronic equivalent only
Requirements
Established patient
No co-pay
With or without video
Cost-share will be waived for all services (including non COVID-19 related services)
For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would be appropriate to assign the code Z03.818: Encounter for observation for suspected exposure to other biological agents ruled out.
For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code Z20.828: Contact with and (suspected) exposure to other viral communicable diseases.
Cigna claims processing systems will be able to accept this coding guidance on April 6, 2020 for dates of service on or after March 2, 2020. Effective through at least May 31, 2020.
Updated 5/22/2020: As federal guidelines continue to evolve in support of the COVID-19 pandemic, Cigna is adopting a position consistent with the federal public health emergency period, which ends July 24, 2020. As such, Cigna is extending the customer cost-share waivers and other enhanced benefits, including our interim virtual care policy, through at least July 31, 2020.
Special Instructions
Use Diagnosis:
– Possible Exposure Z03.818
– Exposure Z20.828
– Other as applicable for non-COVID-19 consults
Virtual or face-to-face visit for screening for suspected or likely COVID-19 exposure
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 – 99201 – 99215
– Modifier CR on CMS 1500 claims
– Condition code DR on UB04 claims
– 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
New or established patient
Cost share will be waived
Services can be performed by phone, video or both
– Cigna will not make any requirements regarding the type of technology used (i.e., phone, video, FaceTime, Skype, etc. are all appropriate to use at this time).
ICD code Z03.818 or Z20.828
For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would be appropriate to assign the code Z03.818: Encounter for observation for suspected exposure to other biological agents ruled out
For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code Z20.828: Contact with and (suspected) exposure to other viral communicable diseases
Codes effective through at least 7/31/2020.
Special Instructions
Use Diagnosis:
– Possible Exposure Z03.818
– Exposure Z20.828
Virtual or face-to-face visit for treatment of a confirmed COVID-19 case
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
Cost-share will be waived. Cigna will reimburse usual face-to-face rates
ICD – B97.29 or U07.1
Codes effective through at least 7/31/2020.
Special Instructions
Use Diagnosis:
– 897.29 or
– U07.41
Telehealth (Non-COVID-19 virtual visit)
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 – 99201–99215
– Append with GQ modifier for virtual care*
– POS normally billed**
*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”.
**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
New or established patients
Services can be performed by phone, video or both
– Cigna will not make any requirements regarding the type of technology used (i.e., phone, video, FaceTime, Skype, etc., are all appropriate to use at this time)
Cigna will reimburse usual face-to-face rates
Standard cost-share will apply
While we encourage providers to bill consistent with an office visit – and understand that certain services can be time consuming and complex even when provided virtually – we strongly encourage providers to be cognizant when billing level four and five codes for virtual services. While we will reimburse these services consistent with face-to-face rates, we will monitor the use of level four and five services to limit fraud, waste and abuse.
Codes effective through at least 7/31/2020.
Special Instructions
Telehealth Visit (Cigna Medicare Advantage and Cigna Medicare-Medicaid)
Provider Type
Qualified Providers
What Is The Service?
A visit with a provider that uses telecommunication systems between provider and patient.
HCPCS / CPT Code
99201-99215 (office or other outpatient visits, new or established patients)
– POS
*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
New or established patients
May take place at a patient’s residence
Telephones that have audio and video capability
Visit will be reimbursed depending on place of service
The following codes should be utilized when COVID-19 is confirmed:
– 897.29
– U07.1
Codes effective through at least 7/31/2020.
Special Instructions
Virtual Check-In (Cigna Medicare Advantage and Cigna Medicare-Medicaid)
Provider Type
Qualified Providers
What Is The Service?
A brief (5-10) minute check-in/conversation with the provider to determine whether office visit or other service is needed.
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 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
G2010
Requirements
Established Patients
With or Without Video
Codes effective through at least 7/31/2020.
Special Instructions
E-Visit (Cigna Medicare Advantage and Cigna Medicare-Medicaid)
Provider Type
Qualified Providers
What Is The Service?
A communication between a patient and their provider through an online patient portal
HCPCS / CPT Code
A communication between a patient and their provider through an online patient portal
99421 (5-10 Minutes)
99422 (11-20 Minutes)
99423 (>21 Minutes)
G2061 (5-10 Minutes)
G2062 (11-20 Minutes)
G2063 (>21 Minutes)
Requirements
Established Patient
Online Patient Portal
Codes effective through at least 7/31/2020.
Special Instructions
Virtual Visit
Provider Type
In-Network Qualified Licensed Healthcare Provider
What is the Service?
Virtual Office Consultation of new or established patient
HCPCS / CPT Code
99241
Virtual Office consultation for a new or established patient, which requires these 3 key components: a problem-focused history; a problem-focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.
Requirements
New or established patient
Will be reimbursed for all other synchronous real-time virtual visits when billed with Place of Service 11
If the visit is related to COVID-19, the ICD10 diagnosis codes (Z03.818 or Z20.828) are required to be billed and reimbursement will be without customer co-pay/cost share
If the virtual visit is not related to COVID-19, the ICD10 code for the visit should be billed and reimbursement will be made according to applicable benefits and related cost share.
No virtual care modifier should be billed
Cigna claims processing systems will be able to accept this coding guidance on April 6, 2020, for dates of service on or after March 2, 2020.
Special Instructions
UnitedHealthcare
Revised June 12, 2020
UnitedHealthcare Expands Access to Care, Support and Resources to Help People and Families Address COVID-19 – March 18, 2020
COVID-19 Telehealth Services – Updated July 10, 2020
¥ Update July 8, 2020: Summary of COVID-19 Dates by Program LINK
§ Update: June 26, 2020: COVID-19 UnitedHealthcare Telehealth Services: Care Provider Coding Guidance LINK
Electronic Visit
Revised June 5, 2020
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
UHC: Last update: June 26, 2020
For Medicare Advantage, Individual and Group Market health plan and Medicaid members, UnitedHealthcare will reimburse for patients to communicate with their doctors using online patient portals, using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable.
Our Medicare Advantage, Medicaid, and Individual and Group Market health plans currently reimburse for “e-visits” for patients to connect with their doctors remotely. 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).
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)
Other qualified non-physician (PT, OT, ST):
G2061 (5-10 minutes)
G2062 (11-20 minutes)
G2063 (>21 minutes)
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 ¥
Special Instructions
Medicare Advantage, Medicaid and commercial – Use of online patient portal
Virtual Check-in: Audio Only
Revised June 5, 2020
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 a new or 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
UHC: Last update: June 26, 2020
“Our Individual and Group market health plans and Medicare Advantage plans currently reimburse for “virtual check-in” patients to connect with their doctors remotely. These services are for new or 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). These services can be billed when furnished through several communication technology modalities, such as telephone (Healthcare Common Procedure Coding System (HCPCS) code G2012) or captured video or image (HCPCS code G2010).”
Telephone evaluation and management service for both physician and qualified non-physician health care professionals (CPT codes 99441-99443 and 98966-98968) can also be used for new or established patients.” ¥
HCPCS / CPT Code
G2012
These virtual check-ins are for patients with a new or 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)
New of 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 ¥
Special Instructions
Commercial, Medicare Advantage, Medicaid, members, UnitedHealthcare reimburses the following audio-only or digital services through several communication technology devices, such as telephone
Medicare Telehealth Visits
Revised June 5, 2020
Provider Type
Eligible Care Providers
What is the Service?
Telehealth
A visit with a provider who uses real-time telecommunication systems between a provider and a patient (telecommunication may use audio-video or audio only)
UnitedHealthcare – Last updated June 29, 2020:
“UnitedHealthcare is waiving the Centers for Medicare and Medicaid (CMS) originating site restriction.” §
“The policy changes apply to members whose benefit plans cover telehealth services and allow those patients to connect with their doctor through live, interactive audio-video or audio-only visits.” §
HCPCS / CPT Code
Common telehealth services include:
99201-99215 (office or other outpatient visits)
– 95 Modifier for Medicare Advantage, Medicaid and individual and fully insured group market health plans. (not required for 99441-99443)
– POS 11, 20, 22 or 23
Audio-only – Medicare Advantage (including DSNP members) must use audio only E/M codes
– 99441-99443 as of May 13, 2020
– POS 11, 20, 22 or 23
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
95 Modifier for Medicare Advantage, Medicaid and individual and fully insured group market health plans. (not required for 99441-99443)
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 ¥
(some of our self-funded customers may not cover provider-based telehealth services under their member benefit plans.)
While the 1135 waiver is in force, care providers may also use telephones that have audio and video capabilities for Medicare or commercial telehealth services during the COVID-19 public health emergency.
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
Special Instructions
Modifier GT, GQ
POS 02
Virtual Check-in: Remote Evaluation of Recorded Video and/or Images
Provider Type
MD/ANP
What is the Service?
Remote evaluation of recorded video and/or images submitted by a new or 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
“Our Individual and Group market health plans and Medicare Advantage plans currently reimburse for “virtual check-in” patients to connect with their doctors remotely. These services are for new or 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). These services can be billed when furnished through several communication technology modalities, such as telephone (Healthcare Common Procedure Coding System (HCPCS) code G2012) or captured video or image (HCPCS code G2010).
Telephone evaluation and management service for both physician and qualified non-physician health care professionals (CPT codes 99441-99443 and 98966-98968) can also be used for new or established patients.”
HCPCS / CPT Code
G2010
Remote evaluation of recorded video and/or images submitted by a new or 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 new or 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 ¥
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 apply
The benefits describe federal requirements and UnitedHealthcare national policy. Additional benefits may be available in some states and under some plans.
Special Instructions
Commercial, Medicare Advantage, Medicaid, members, UnitedHealthcare reimburses the captured video or image
Other Telehealth Visits
Revised June 5, 2020
Provider Type
What Is The Service?
UnitedHealthcare is allowing all codes on the CMS Covered Telehealth Services list for this national emergency for Medicare Advantage, Medicaid*, and Individual and Group Market health plans.
Guidance for physical, occupational and speech therapy can be found here and here. ¥ §
For all other questions, you may either contact your local UnitedHealthcare representative, or visit the UnitedHealthcare COVID-19 web page
Last updated June 26, 2020.
HCPCS / CPT Code
Requirements
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 ¥
Special Instructions
Humana/TRICARE
Revised July 10, 2020
Telemedicine
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
Humana understands that not all telehealth visits will involve the use of both video and audio interactions. For providers or members who don’t have access to secure video systems, we will temporarily accept telephone (audio-only) visits. These visits can be submitted and reimbursed as telehealth visits.
Please follow CMS or state-specific guidelines and bill as you would a standard telehealth visit.
In response to this emergency, Humana will temporarily reimburse for telehealth visits with participating/in-network providers at the same rate as in-office visits. In order to qualify for reimbursement, telehealth visits must meet medical necessity criteria, as well as all applicable coverage guidelines.
To encourage members to seek care safely while protecting the health care workforce, Humana is waiving member cost share for all telehealth services delivered by participating/in-network providers. This includes:
– All telehealth services delivered by participating/in-network providers, either through audio or video
– All telehealth services delivered through MDLive to Medicare Advantage members, and also to Commercial members in Puerto Rico
– All telehealth services delivered through Doctor on Demand to Commercial members
• Please do not collect traditional member responsibility for these services from any Humana member, as it will result in avoidable refund transactions and may inhibit members from seeking needed care.
Beginning March 6, 2020 and for the duration of the COVID-19 public health emergency
*Cost Share waivers are effective May 1 through remainder of 2020. https://press.humana.com/press-release/humana-waive-member-costs-all-primary-care-and-behavioral-health-office-visits-medicar
*Eliminating out-of-pocket costs for office visits so that Medicare Advantage members can reconnect with their health care providers (all telehealth visits- PCP, Specialty and Behavioral Health for in-network providers.
Special Instructions
E-Visit
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
Please follow CMS or state-specific guidelines and bill as you would a standard telehealth visit.
In response to this emergency, Humana will temporarily reimburse for telehealth visits with participating/in-network providers at the same rate as in-office visits. In order to qualify for reimbursement, telehealth visits must meet medical necessity criteria, as well as all applicable coverage guidelines.
To encourage members to seek care safely while protecting the health care workforce, Humana is waiving member cost share for all telehealth services delivered by participating/in-network providers.
Early prescription refills allowed through July 25, 2020
See payer details for cost sharing information
Special Instructions
Telephone Visits
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
Special Instructions
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
Virtual Check-In
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
Special Instructions
Online Digital Evaluation and Management
Provider Type
Qualified nonphysician health care professional
What Is The Service?
Online digital evaluation and management service by a qualified nonphysician health care professional
HCPCS / CPT Code
Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days;
98970 – 5-10 minutes
98971 – 11-20 minutes
98972 – 21 or more minutes
Requirements
Service for established patient
Special Instructions
Telephone Assessment
Provider Type
Qualified nonphysician health care professional
What Is The Service?
Brief communication by a qualified nonphysician health care professional
HCPCS / CPT Code
Telephone evaluation and management service by a physician or other qualified nonphysician 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;
98966 – 5-10 minutes
98967 – 11-20 minutes
98968 – 21-30 minutes of medical discussion
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
Special Instructions
Telehealth Services
Provider Type
What Is The Service?
Effective 4/23/2020 – TRICARE has approved use of telehealth services to include otherwise-covered behavioral health services during the COVID-19 outbreak
HCPCS / CPT Code
Telehealth services to include otherwise-covered behavioral health services during the COVID-19 outbreak
Requirements
These services include:
– Telemental health services, including individual psychotherapy, crisis management, family therapy or group therapy (expected to continue after the coronavirus pandemic)
– Medication assisted treatment (only during the coronavirus pandemic)
– Opioid treatment programs (only during the coronavirus pandemic)
– Intensive outpatient programs, including medication management, case management, recreational therapy, occupational therapy and discharge planning (only during the coronavirus pandemic)
Refer to your TRICARE portal for policy update details