State-based commercial insurers’ COVID-19 telehealth policies

Reference: Premera Blue Cross response to COVID-19

Audio-only phone services: Yes

Reimbursement: parity, etc.: Reimbursement consistent with an in-office visit during the public health emergency. This change is in effect through June 30, 2020, per CMS guidance.

Waiver of copays, etc.: Telehealth cost share waivers ended on January 1, 2021.

Originating/receiving sites: Providers who are located at an “originating site” (where the patient is located) may submit a fee for hosting the patient using the following HCPCS code without any modifiers: Q3014—Telehealth originating site facility fee.

Telehealth services approved for new patients: Providers can care for new patients via a telehealth virtual encounter and bill those services using the appropriate CPT that reflects the services rendered, in addition to the telehealth modifier and place of service.

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: in-network providers only; additional options for virtual care include (not required): Doctor on Demand, Boulder Care (video-based treatment of opioid use disorder), and WorkIt Health (video-based treatment for alcohol use disorder).

Billing guidance: Use appropriate Modifier (95, GQ,GT,GO) and POS (02), POS code 11—Office isn’t appropriate for telehealth services rendered via a HIPAA compliant telecommunications system.

Distance sites: N/A

Reference: COVID-19 Provider Updates

Audio-only phone services: Audio and video services permitted. Audio-only visits are also covered if the service (previously done in an office) can be effectively rendered via telephone (bill with virtual service codes 99441-99443).

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: Services covered and cost share temporarily waived with the exception of patients with BCBSAZ self-funded and TPA-administered plans and BlueCard^® plans (from other BCBS companies). FEP cost share waived for COVID-19 diagnoses, testing, and treatment only (must be consistent with CDC guidelines).

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Out-of-network coverage for non-COVID-19 care is not covered. Some out-of-network care for COVID-19 care is covered (for fully insured plans, self-funded plans, and TPA-administered plans). Most in-network care covered, with exceptions in certain cases where what is covered and not covered is determined by the employer group.

Billing guidance:

• For reimbursement equivalent to an in-person visit for members with commercial plans, please bill with the procedure code you normally use and add telemedicine modifier 95 or GT. These modifiers work for both audio/video and telephone-only visits.
• For professional claims, use place of service (POS) 02.
• For facility claims, no POS is necessary

Distance sites: N/A

Reference: Telehealth and other virtual care (PDF, 192KB)

Audio-only phone services: Providers may use nonpublic facing remote audio and/or video communication services to communicate with their patients

Reimbursement: parity, etc.: Yes, reimbursement for services will be provided at your usual contract rate.

Waiver of copays, etc.: Standard coverage and out-of-pocket costs apply and based on plan coverage.

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In the case of a medical emergency, care provided by network and out-of-network providers will be covered for all plans. However, higher out-of-pocket expenses may occur for out-of-network service.

Some plans may also have access to Teladoc, Heal™, or NurseHelp 24/7℠ as alternative options for virtual care.

Billing guidance: Providers who are contracted with Blue Shield should use the same billing codes for all professional and ancillary services and indicate an “02” for place of service.

Distance sites: N/A

Additional information: Encourages use of HIPAA-compliant platform. We know, however, that some providers are not set up to conduct HIPAA-compliant telehealth and may want to use other platforms during this public health emergency. Approved emergency telehealth options are listed below. Providers may use nonpublic facing remote audio and/or video communication services to communicate with their patients.

These services include, but are not limited to:

• Doxy.me
• Facebook Messenger
• Facetime
• Google G Suite Hangouts Meet
• Google Hangouts
• Skype
• Skype for Business
• Updox
• VSee
• Zoom for Healthcare

References:

• ConnectiCare—Coronavirus (COVID-19)
• Payment policy: COVID-19 billing guidelines (PDF, 322KB)
• Connecticut Governor Lamont expands access to telehealth services in response to COVID-19 pandemic
• Temporary payment policy: Supplemental telehealth guidelines (PDF, 735KB)
• Telehealth/Telemedicine and Telephone Call FAQs (PDF, 138KB)

Audio-only phone services: To bill telephone only services, use 99441- 99443.

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: Virtual Check-ins: covered for Medicare Advantage plans; for commercial plans cost share waived for in-network providers March 1, 2020 through September 9, 2020 (as of September 10, 2020 usual cost share applies). Telehealth (Behavioral Health): For Medicare Advantage plans cost-share waived August 1, 2020–December 31, 2020 or end of Federal PHE, whichever is first; for commercial plans cost share waived for in-network providers March 1, 2020 through September 9, 2020 (as of September 10, 2020 usual cost share applies).

Originating/receiving sites: Home

Telehealth services approved for new patients: Yes

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-Network only; MDLive and Teledoc optional

Billing guidance: In order to identify telehealth or telephone services that were historically performed in the office or other in person setting (e.g. POS 11, 19 and 22) a modifier GT or 95 (or GQ for Medicaid) must be used. Place of Service 02 will reimburse at traditional telehealth rates.

Distance sites: N/A

Reference:

• COVID-19 Provider Billing Guidelines (As of June 16, 2021)
• COVID-19 Update (PDF, 326KB) (As of April 29, 2021)

Audio-only phone services: Audio-only visits provided consistently with CMS guidelines will be covered for Medicare Advantage members. Florida Blue is temporarily allowing audio-only virtual visits if video capability is not available. Audio-only virtual visits provided consistently with virtual visit billing guidelines will be covered for Commercial / Affordable Care Act (ACA) members. Note: The State Group will not cover audio-only virtual visits. Please refer to the member’s plan on their insurance card.

Reimbursement: parity, etc.: Reimbursement based on current fee schedule

Waiver of copays, etc.: The member’s current cost share for virtual visits will be waived for dates of service from June 1, 2020 to July 20, 2021 (commercial); June 1, 2020 and until CMS directs otherwise (Medicare). Teladoc visits are at $0 cost share to members through Florida Blue through July 20, 2021

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Florida Blue and New Directions Contracted Behavioral Health Providers and Outpatient Facilities. For Medicare Advantage plans: If a medically necessary service (including labs) is not available from an in-network provider, members may seek care from an out-of-network provider and claims will process at the in-network benefit Teledoc Optional.

Billing guidance: Use GT or 95 modifiers and POS 02; The place of service should be the regular place of service as if you saw the patient in-person (for facilities)

Distance sites: N/A

References:

• Ambetter from Peach State Health Plan covered services and authorization guidelines (PDF, 1.25MB)
• Coronavirus guidance
• What you need to know about Coronavirus (FAQs)

Audio-only phone services: Unclear

Reimbursement: parity, etc.: Same as in-person

Waiver of copays, etc.: There is no co-pay associated with Teladoc visits, however, coinsurance and deductible may apply to some plans for the session. Out-of-pocket costs based on health plan coverage.

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Ambetter has partnered with Teledoc, however, as the demand for virtual visits increases, telehealth consultations may be scheduled with PCPs.

Billing guidance: N/A

Distance sites: N/A

References:

• MA PAP111—Billing requirements for federally qualified health centers (FQHCS)
• Coronavirus updates
• Notice of Benefit Changes for COVID-19 (PDF, 110KB)
• Supplement to Notice of Benefit Changes for COVID-19 (PDF, 95KB)
• Telehealth Virtual Services Policy
• Telehealth Virtual Services Clarification (PDF, 223KB)

Audio-only phone services: Yes

Reimbursement: parity, etc.: N/A

Waiver of copays, etc.: As of January 1, 2021, benefits are subject to ordinary Deductible, Coinsurance, and Copayment requirements, as applicable.

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: No—Telehealth policy only applies to in-network. If a plan offers MDLIVE and other telehealth benefits, you may see two different benefit descriptors under the member benefits display: Telehealth Services (MDLIVE) and Telehealth Virtual Care. Telehealth Virtual Care Services—Not Participating indicates member does not have a telehealth benefit. If you see Telehealth Services but not Telehealth Virtual Care or neither of these options listed, please be assured that member has the full telehealth virtual care benefit.

Billing guidance: Telehealth services must be submitted with a Place of Service “02”; Modifiers 95, GT, GQ.

Distance sites: N/A

Reference: COVID-19 provider information

Audio-only phone services: For providers or members who don’t have access to secure video systems, telephone (audio-only) visits can be used for the virtual visit. Please use both Telehealth as Place of Service (02) and GT modifier for audio-only visits.

Reimbursement: parity, etc.: Telehealth/Virtual Services will continue to be paid at parity to in-person services.

Waiver of copays, etc.: Fully insured members are responsible for their cost-share (co-pay, deductible) for telehealth and virtual services, with the exception of treatment for COVID-19. Administrative Service Only (ASO) groups can choose to waive or not waive member cost share as of July 1, 2020. 

Originating/receiving sites: N/A

Telehealth services approved for new patients: Limited to patient-initiated visits only

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only. BCBSKS members can also contact American Well as a virtual care benefit. Federal Employee Program (FEP) members can only access virtual care through the Teledoc service.

Billing guidance: The place of service 02 and GT modifier should be used; the most appropriate code for the service provided should be billed. 

Distance sites: N/A

References:

• COVID-19 Info for Clinical Partners
• COVID-19 Temporary Payment Policy (PDF, 390KB)
• COVID-19 Updates (Effective July 1, 2021)

Audio-only phone services: For all covered CPT codes

Reimbursement: parity, etc.: Same as in-person

Waiver of copays, etc.: Effective July 1, 2021—Member cost share reinstated for non-COVID telehealth services. These changes do not apply to Medicare Advantage members. For Federal Employee Program (FEP) member cost share waived for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network.

Normal authorization processes resumed for all services for commercial and Federal Employee Program members, and will start requiring authorization for Medicare Advantage members on July 1, 2021.

Originating/receiving sites: For telehealth services in a member’s home Blue Cross will treat POS 02 and POS 11 the same to allow the provider to be reimbursed at the office rate.

For new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only

Billing guidance: When you provide any telephonic services, do not bill the specific telephonic CPT codes. Bill all covered services that you render either by telehealth or telephone as if you are performing a face-to-face service using the codes that are currently on your fee schedule. You must use one of the following telehealth modifiers (GT, 95, G0, and GQ) and the applicable place of service code as noted above. This will enable us to pay you the same rate we pay you for in-person, face-to-face visits. Blue Cross will allow the use of these modifiers for any service on your fee schedule during the COVID-19 Massachusetts state of emergency. The system will not distinguish between a COVID visit and a non-COVID visit; therefore, it is recommended that you bill the member for the applicable cost share once the claim has processed to ensure you do not have to reimburse the member.

Distance sites: N/A

References:

• Coronavirus (COVID-19) updates for providers
• Temporary COVID-19 Telehealth Payment Policy (PDF, 179KB)

Audio-only phone services: The use of audio without video is acceptable.

Reimbursement: parity, etc.: N/A

Waiver of copays, etc.: There is no member responsibility for covered services for Tufts Health Plan SCO members, Tufts Health Unify, Tufts Health Together or Tufts Health RITogether members.

The following self-insured groups continue to waive cost share for in-network telehealth services:

• Cape Cod Healthcare for behavioral health and substance use disorder services only
• Excel Academy
• Lasell University
• Sturdy Memorial Hospital
• Tufts Health Plan
• Tufts University
• Wentworth Douglass Hospital

Referrals and prior authorization are not required for in-network telehealth services.

Originating/receiving sites: N/A

Telehealth services approved for new patients: Yes

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: For dates of service after July 20, 2020, pre-COVID coverage policies and benefits (including applicable cost share) will apply for out-of-network telemedicine. Providers do not need to use Teladoc to provide services to members. Teladoc is an additional benefit available to Commercial members.

Billing guidance: Providers should submit claims for telehealth visits, as outlined below.

Commercial and Tufts Health Direct: Submit claims with place of service (POS) 02 or the appropriate telehealth modifiers (see table below) to differentiate a telehealth visit from an in-person visit. Note: Tufts Health Plan will accept the POS that would have been used, had the services been rendered in person, provided the appropriate telehealth modifier is also on the claim to indicate a telehealth visit.

Tufts Medicare Preferred: In accordance with CMS guidelines, submit claims with modifier 95 to indicate a telehealth visit. Note: Providers should not submit claims with GO or GQ modifiers.

Tufts Health Plan SCO and Tufts Health Unify: In accordance with CMS and MassHealth guidelines, submit claims with modifiers GT and 95 and POS 02.

Tufts Health Together: In accordance with MassHealth requirements, submit claims with modifier GT and POS 02.

Facility Claims: For facility claims, providers should submit the appropriate Revenue Code, CPT/HCPCS code(s) and modifier(s).

Tufts Health Plan SCO, Tufts Health Unify, Tufts Health Together: In accordance with CMS guidelines, submit claims with modifiers GT and POS 02.

In addition to the guidelines above, providers should continue to bill with the appropriate license-level modifier and all other billing guidelines as specified in the applicable payment policy.

Distance sites: N/A

Additional information: Prior authorization and notification is not required for the following services: Applied Behavioral Analysis (ABA) for all products, Children’s Behavioral Health Initiative (CBHI) for Tufts Health Together, Behavioral Health for Children and Adolescents (BHCA) for Massachusetts Commercial products, Home-Based Therapeutic Services (HBTS) for Tufts Health RITogether. There are no restrictions on service type, including individual and group behavioral health services. Additionally, the usage of audio without video is acceptable.

References:

• Telehealth for behavioral health providers (PDF, 334KB)
• Telehealth procedure codes for COVID-19 (PDF, 169KB)
• Michigan telemedicine policy, simplified
• Telehealth FAQs for Providers (PDF, 275KB)

Audio-only phone services: In addition to visits that use audiovisual technology, Blue Cross and BCN will cover telephone-only behavioral health visits for all services for which telemedicine is payable for Blue Cross’ PPO, Medicare Plus Blue, BCN commercial, and BCN Advantage members.

Reimbursement: parity, etc.: Eligible providers bill same as face-to-face visit

Waiver of copays, etc.: Cost-share waiver concluded December 31, 2020

Originating/receiving sites: Originating site requirement removed

Telehealth services approved for new patients: Not specified

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only for telehealth. Blue Cross Online Visit Providers contracted with Amwell

Billing guidance: During the COVID-19 pandemic, providers can temporarily use POS equal to what it would have been had the service been furnished in-person instead of using POS 02. The GT or 95 modifier is still required to ensure that cost share is waived for appropriate services.

Distance sites: Not specified

References:

• COVID-19: virtual visits and telehealth
• Telephone visits, evisits, and hosted visits
• COVID-19: Coverage for Priority Health Members

Audio-only phone services: Yes, 98966-98968

Reimbursement: parity, etc.: As of May 1, 2021, transitioned back to normal billing process but will continue to reimburse at a nonfacility rate.

Waiver of copays, etc.: Member costs for telehealth services vary by plan. Many plans that had $0 cost share have returned to the member’s standard benefit offering. Some plans will continue to have $0 cost share through December 31, 2021.

Originating/receiving sites: N/A

Telehealth services approved for new patients: Not specified

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Out-of-network virtual visits are typically not covered but have been due to COVID-19 as a service to members. This exemption will continue through July 31, 2021. After that, out-of-network virtual visits will not be covered.

Billing guidance: As of March 1, 2021, submit telehealth billing with the correct site of service code (02). Commercial billing no longer requires the GT and 95 modifiers.

Distance sites: Distant site telehealth services furnished by facility-based providers, RHC and FQHCs are reported with the appropriate CPT or HCPCS code that falls within their scope of practice and within their fee schedule.

Reference: Coronavirus Information for Providers

Audio-only phone services: Telehealth may be provided over the phone

Reimbursement: parity, etc.: Yes, except for codes that are by definition provided in a facility (example: 99231—Subsequent Hospital Care)

Waiver of copays, etc.: As of June 15, with the exception of COVID-related visits, Doctor On Demand appointments will no longer be covered at zero cost-share.

Originating/receiving sites: N/A

Telehealth services approved for new patients: Blue Cross is waiving the restriction of providing telehealth and telephone visits to established patients to allow the services to be provided to new patients

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only; Doctor on Demand Optional

Billing guidance: Commercial claims for telehealth services submitted on a professional claim should be submitted with place of service 02. The procedure code should match the procedure code that would have been billed for a face-to-face service. The modifier -95 may be appended. For commercial members, telehealth services are reimbursed at the same rate as they would be for a face-to-face encounter in an office setting (place of service 11). Blue Cross will also accept commercial telehealth claims submitted in alignment with CMS, with the place of service that would have been used if the service was provided face-to-face, with modifier -95 appended to the procedure code. In order to obtain payment parity for clinic services, telehealth claims for Medicare members should be submitted with the place of service that would have been used if the service was provided face-to-face with modifier -95 appended to the procedure codes. If place of service 02 is submitted, the claim will apply the facility place of service allowance.

Distance sites: N/A

Additional information: Telehealth may be provided over a non-HIPAA compliant audio-visual application, such as Skype or FaceTime

References:

• Provider payment and coding policies
• Latest updates on COVID-19

Audio-only phone services: Behavioral health provider telephonic (call) therapy visits allowed.

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: Members will pay $0 for telehealth December 31, 2021

Originating/receiving sites: The originating site is the location where the patient is located and receives medical services through a telecommunications system.

Telehealth services approved for new patients: Not specified

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only. Members have option for virtual visits with provider or through Blue KC virtual care provider, Amwell

Billing guidance: Must use in-person therapy visit code, POS 02, and modifiers 95, G0, GT, and GQ

Distance sites: Distant site clinical psychologists can provide and receive payment for covered telehealth services.

Reference:

• General policies and procedures manual (PDF, 2MB)
• COVID-19 FAQs for providers

Audio-only phone services: Will accept telehealth charges from any credentialed provider with no video component required during this pandemic urgency period

Reimbursement: parity, etc.: Eligible providers paid at regular fee schedule level

Waiver of copays, etc.: Member cost shares apply for telehealth services.

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Out-of-network telehealth services will be covered at no cost to the member if related to COVID-19 diagnostic testing. Members have option for virtual visits with provider or through BCBSNE’s preferred telehealth provider, Amwell.

Billing guidance: Providers may bill using E&M codes, therapy codes, or telehealth codes and must use the modifier 95 and POS 02 for reimbursement.

Distance sites: N/A

References:

• COVID-19 Updates for Members
• COVID-19 Updates for Providers
• Temporary COVID-19 Telehealth Payment Policy (PDF, 179KB)

Audio-only Phone Services: Telehealth also includes telephone consultation.

Reimbursement: parity, etc.: Tufts Health Plan will compensate in-network providers at 100% of their contracted rate for services rendered in person, as specified in provider agreements, until further notice. The telehealth reduction will not apply.

Waiver of copays, etc.: Applicable member copays and other applicable cost share will continue to be waived for COVID-19- related, in-network, medically necessary services. A COVID-19 diagnosis must be submitted on the claim for the waived cost share to continue to apply. Telehealth visits through Teladoc will continue to have no cost share.

The following self-insured groups continue to waive cost share for in-network telehealth services:

• Cape Cod Healthcare for behavioral health and substance use disorder services only.
• Excel Academy
• Lasell University
• Sturdy Memorial Hospital
• Tufts Health Plan
• Tufts University
• Wentworth Douglass Hospital

Originating/receiving sites: N/A

Telehealth Services Approved for New Patients: Yes

Telehealth policy applies to Out of Network? Services limited to Telehealth carve out company, e.g., Teladoc, MDLive: Standard coverage policies and benefits (including applicable cost share) apply for out-of-network (OON) telemedicine services. Access to Teladoc based on member plan

Billing guidance: Providers should submit claims for telehealth visits, as outlined below:

Commercial and Tufts Health Direct

• Submit claims with place of service (POS) 02 or the appropriate telehealth modifiers (see table below) to differentiate a telehealth visit from an in-person visit.
• Tufts Health Plan will accept the POS that would have been used had the services been rendered in person, provided the appropriate telehealth modifier is also on the claim to indicate a telehealth visit.

Tufts Medicare Preferred

• In accordance with CMS guidelines, submit claims with modifier 95
• Do not submit claims with modifiers GO or GQ

Tufts Health Plan SCO and Tufts Health Unify

• In accordance with CMS and MassHealth guidelines, submit claims with modifiers GT and 95 and POS 02.

Tufts Health Together

• In accordance with MassHealth requirements, submit claims with modifier GT and POS 02.

Tufts Health RITogether

• In accordance with Rhode Island EOHHS requirements, submit claims with POS 02. Effective for dates of service on or after February 1, 2021, telehealth claims submitted with a POS other than POS 02 will deny.

Distance Sites: N/A

References:

• Telemedicine services
• Commercial and ASO existing and extended telemedicine policy codes (PDF, 2.5MB)
• COVID-19 information
• Behavioral health continuity during COVID-19 (PDF, 1.2MB)

Audio-only phone services: Telephonic care for “all covered services including diagnosis or treatment of COVID-19, routine care, therapy, or mental health care”

Reimbursement: parity, etc.: N/A

Waiver of copays, etc.: Member’s cost share (copayment, deductibles, coinsurance) waived for the duration of the Public Health Emergency regardless of diagnosis, with the following exceptions:

• ASO groups (only for a diagnosis of COVID-19)
• When performed by an out-of-network provider

Authorization and referral requirements are waived for telemedicine services during this temporary expansion.

Originating/receiving sites: N/A

Telehealth services approved for new patients: Yes

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only for telehealth. When a Horizon BCBSNJ member has out-of-network benefits, and the member chooses to get care from out-of-network health care professionals, telemedicine and telephone visits are available, but the member is responsible for the difference between the plan allowance and the billed amount.

Billing guidance: Use CMS designated POS 02 or 11 and append 95 or GT modifiers where applicable to the appropriate procedure code.

Distance sites: N/A

Reference:

• Presbyterian Health Plan—Behavioral health telemedicine and telephonic billing guidelines (PDF, 168KB)
• COVID-19 Specialty Behavioral Health Service Guideline (PDF, 951KB)
• COVID-19 PHP Telehealth Provider Instruction ABA (PDF, 187KB)

Audio-only phone services: Allowed

Reimbursement: parity, etc.: services are paid as if members received services on-site and in person

Waiver of copays, etc.: N/A

Originating/receiving sites: N/A

Telehealth services approved for new patients: Yes

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: N/A

Billing guidance: Providers are directed to bill for BH telephonic visits using location code 02—Telephonic Visit on the claim form. If location code 02 is on the claim form, the services are billable to the MCO and should be paid at the normal rate for the service. All other normal modifiers should be included on the claim if otherwise required. The originating site HCPCS code Q3014 is not billable for these services since the normal office visit payment is to be made instead. FQHCs and other facilities that are not able to use location code 02 on the claim may use revenue code 0728 on the claim.

Distance sites: N/A

Reference:

• COVID-19 coronavirus information for providers (PDF, 225KB)
• True Health New Mexico Provider Handbook (PDF, 984KB)

Audio-only phone services: “If you do not have access to a secure video system, you may use telephone (audio-only) visits in place of the telehealth system. In this case, please use POS code 02 and the CR (catastrophe/disaster-related) modifier.”

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: Does not specify about possible waivers of cost sharing outside of COVID-19 treatment and diagnosis.

Originating/receiving sites: N/A

Telehealth services approved for new patients: New patients can join if they underwent a “qualifying event.”

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: N/A

Billing guidance: “If billing using a HCFA-1500, please use place of service (POS) code 02 when filing your telehealth claims. Inclusion of modifiers GT, GQ, and G0 are not required, but are accepted:

• If billing using a UB-04, please include modifier 95 for telehealth claims.
• If you do not have access to a secure video system, you may use telephone (audio-only) visits in place of the telehealth system. In this case, please use POS code 02 and the CR (catastrophe/disaster-related) modifier.

Behavioral health providers may also conduct outpatient visits telephonically as described above.”

Distance sites: N/A

References:

• Excellus BlueCross BlueShield code guidance for most common telehealth services (PDF, 99KB)
• Excellus BCBS updates on COVID-19 (coronavirus)

Audio-only phone services: Audio-only is allowed but New York state requires using the GQ modifier for these visits (during state of emergency only)

Reimbursement: parity, etc.: “We will continue to reimburse all telehealth services at the same rate as the corresponding face-to-face CPT/HCPCS code. This applies to all lines of business and may be extended for some or all programs based upon NYS and/or federal requirements. We provide advance written notice of any reimbursement updates for telehealth services.”

Waiver of copays, etc.: For members covered by commercial fully insured products and members enrolled in self-funded groups that have opted in to waive member cost-share, we will reinstitute the customer cost-share responsibility under the member’s benefit for non-COVID-19 telehealth services when the NYS emergency regulation expires (refer to the Regulatory Time Frames tab for current expiration date). *Please note: Self-funded groups may have different cost-share waiver arrangements for telehealth services and COVID-19 treatment, so please check member coverage before each visit to determine member cost-share responsibility.

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only and for services that would be covered normally

Billing guidance: N/A

Distance sites: N/A

*Services covered via telehealth during COVID-19 state of emergency only (per telehealth coding guidance grid [updated January 15, 2021])

References:

• Coronavirus (COVID-19) update
• Coronavirus (COVID-19) frequently asked questions
• Temporary Payment Policy: Supplemental Telehealth and audio only Telephone Guidelines—All Lines of Business (PDF, 922KB)

Audio-only phone services: Provider can use either telephone or telehealth visits as long as they comply with Emblem Health requirements

Reimbursement: parity, etc.: N/A

Waiver of copays, etc.: Cost-sharing waivers for non-COVID-19 related telehealth services expired for Medicare members on September 9, 2021 and for members in other plans on June 4, 2021. Regarding Teladoc services, cost-sharing waivers ended December 31, 2020 for Medicare plans, September 9, 2020 for ASO plans, and June 4, 2021 for members in all other plans.

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only

Billing guidance: Modifiers: GT—via interactive audio and video telecommunication systems; 95—synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system; GQ—telephone audio only services and store and forward (Medicaid only)

Distance sites: N/A

References:

• COVID-19 provider resources: Clarification on claims and reimbursement for telehealth
• Blue Cross and Blue Shield of North Carolina (Blue Cross NC): Frequently asked questions from providers (PDF, 471KB)
• CMS list of telehealth services
• Temporary Expansion of Reimbursement for Telehealth (PDF, 401KB)
• COVID-19 Support Measures: Details and Coding Guidance

Audio-only phone services: For providers or members who don’t have access to secure video systems, telephone/audio-only visits can be used for the virtual visit

Reimbursement: parity, etc.: Visits to providers that previously required an in-person encounter can be performed virtually and will be paid at parity with office visits as long as they are medically necessary, meet criteria in the updated Blue Cross NC Telehealth Corporate Reimbursement Policy, and occur on or after March 6, 2020.

Waiver of copays, etc.: Blue Cross NC is waiving all copays for in-network primary care and outpatient behavioral health visits for Medicare Advantage members from June 1, 2020 through the end of 2020. Visits do not have to be related to COVID-19 and can be done in person or virtually through telehealth.

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Will waive cost sharing for all telehealth visits conducted through MDLive and/or Teladoc, regardless of if the visit is COVID-19 related. This will take effect for claims incurred on and after March 6, 2020 and will remain in effect until June 4. This is applicable only to fully insured individual and group customers and high deductible health plans that offer MDLive or Teladoc as benefits through their Blue Cross NC plan. We offered the provision to our Administrative Services Only (ASO) groups via an opt-out process (the deadline was March 31, 2020 to opt out).

Billing guidance: Use Place of Service (02) for telehealth visits

• Exception: Urgent care and facility providers should bill the same as if the services were face to face.
• For audio-only visits: Use Place of Service (02) and modifier -CR (catastrophe/disaster-related). For visits that use video, you do not need to include the modifier. You only need Place of Service (02).

Modifiers -95 and -GT are allowed but not required.

For services that must be done in a face-to-face encounter (i.e. labs, injections), do not use Place of Service (02).

Distance sites: N/A

Reference:

• Billing and coding guidelines during COVID-19
• Telehealth Services

Audio-only phone services: N/A

Reimbursement: parity, etc.: N/A

Waiver of copays, etc.: BCBSND fully insured products will waive cost-sharing for all telehealth services

Originating/receiving sites: Separate payment will be made if patient is physically present at an originating site location such as a clinic or facility setting. Separate payment for the originating site location where the patient is participating with a distant site practitioner will not be reimbursed if it is the patient’s home, community setting, or other nonprovider-owned location.

Telehealth services approved for new patients: Yes, for telehealth E&M and inpatient but no for virtual check-ins and digital visits (patient-initiated via online patient portal).

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: The expanded telehealth benefit includes telehealth visits from local participating providers and AmWell. The Federal Employee Program (FEP) has expanded telehealth services to allow non-Teladoc telehealth services. Services performed by non-Teladoc providers and not related to COVID-19 will apply cost shares.

Billing guidance: Bill telehealth services on the CMS-1500 Claim Form unless specifically noted below in which case they can be billed on a UB-04 Claim Form. CMS-1500 Claim Form telehealth service billing requirements are:

• Bill appropriate code for service rendered
• Modifier 95: synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system
• POS 02: telehealth

Distance sites: N/A

Reference:

• COVID-19 information for members
• COVID-19 frequently asked questions for providers (PDF, 268KB)
• Ohio Revised Code Section 3902.30

Audio-only phone services: At this time, Medical Mutual is waiving the requirement that telehealth (telemedicine) visits have a visual encounter. Therefore, telephonic visits with an audio-only connection will be covered. ABA services must include both a visual and an audio component.

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: Telemedicine visits not related to COVID-19 diagnosis are being covered at a member’s benefit level. Cost sharing is applied according to benefits.

Originating/receiving sites: N/A

Telehealth services approved for new patients: Medical Mutual is waiving the requirement that an initial behavioral health visit be done in person before visits can be conducted via telehealth (telemedicine). This applies only to scheduled visits and does not include on-demand telehealth (telemedicine) providers.

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Some Medical Mutual members covered by self-funded plans may have benefits for 24/7 on-demand telehealth (telemedicine) services through national vendors or platforms offered through hospital systems. On-demand virtual visits are a subset of telehealth (telemedicine). Behavioral health visits are not covered as on-demand virtual visits.

Billing guidance: N/A

Distance sites: N/A

Additional information: For plans subject to the jurisdiction of the Ohio Department of Insurance, the bulletin released on March 20, 2020 states that testing and treatment for COVID-19 are included in the definition of an emergency medical condition. For these plans, Medical Mutual will follow member cost sharing for services related to the treatment of COVID-19 received from an out-of-network provider the same as if the member received treatment from an in-network provider.

References:

• CMS list of telehealth services
• Medicaid telemedicine and telehealth overview and guidelines (PDF, 214KB)
• Reimbursement policy: Telehealth and telemedicine expanded services for COVID-19 (PDF, 273KB)
• Telehealth and Telemedicine (update April 14, 2021) (PDF, 428KB)

Audio-only phone services:

• Commercial Oregon plans: “Telehealth services have been expanded to include communication methods that are not real-time and/or do not include audio-visual communication. Many of these are not normally a covered benefit on our standard plans. This includes telephone only”
• Commercial Alaska plans: “Telemedicine services are not eligible for reimbursement when: Audio-only conferencing or audio-web conferencing without person-to-person video abilities is used.”
• Medicaid: “Services must be provided using real-time, interactive audio and video telecommunications system.”
• Medicare: “Services must be provided using real-time, interactive audio and video telecommunications system."

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: Commercial: No cost share for the visit when COVID-19 testing is performed or ordered.

Originating/receiving sites: Commercial Oregon and Alaska Plans:

1. An originating site fee may not be billed when the patient is located at home or at a self-service kiosk.
2. The originating site (office or facility where the patient was located at the time of the telemedicine professional service) may submit an originating site facility fee for telemedicine services with HCPCS code Q3014 and one unit per provider of telemedicine services.

Medicare: Specific locations must be used.

1. The member must be in a geographic location designated by CMS as a qualifying rural area.
2. While receiving telemedicine services, the member must be located at one of the following Medicare-approved “originating sites” (MLN5 )—see Telehealth and Telemedicine link for list of approved “originating sites”

Medicaid: Specific locations must be used. The member must be located at one of the following Medicare-approved “originating sites” (MLN5 )—see Telehealth and Telemedicine link for list of approved “originating sites”

Telehealth services approved for new patients: E-visits and Virtual Check-ins

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: N/A

Billing guidance:

Commercial Oregon and Alaska Plans: Report the primary service(s) using the appropriate CPT or HCPCS code(s) for the professional service(s) performed.

1. Report with place of service (POS) 02. (MLN12, CMS13)
2. Append modifier GQ, modifier 95, or modifier GT to the procedure code to indicate the type of transmission technology used.

Medicare: The services must be on the list of Medicare-approved telemedicine procedure codes applicable for the date of service year (list available on CMS website)

1. Covered telemedicine procedure codes must be submitted with place of service 02. The use telehealth POS 02 certifies that the service meets the telehealth requirements. (CMS14)
2. The rules for modifier GT have changed for Medicare Advantage claims.
   1. For distant site services billed under Critical Access Hospital (CAH) method II on institutional claims, the GT modifier will still be required. (CMS14)
   2. For non-CAH facilities with dates of service January 1, 2017 through September 30, 2018, the optional use of modifier GT will not result in denial as an inappropriate modifier.
   3. For non-CAH facilities with dates of service October 1, 2018 and following, claims billed with modifier GT will be denied to provider liability. (CMS15) Per CMS, for dates of service October 1, 2018 and following, modifier GT is nly allowed on institutional claims billed under CAH Method II billing. (CMSX)
   4. For professional claims, POS 02 is sufficient; modifier GT is not required. There is currently no known CMS guidance to deny professional claims submitted with modifier GT, however Moda Health requests modifier GT no longer be used on Medicare Advantage nonCAH professional claims.
3. The GQ modifier is still required when applicable.
4. Do not use modifier 95 for Medicare Advantage telemedicine services.
5. Use modifier G0 (G Zero) for telehealth services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke. (MLN17)

Medicaid: The services must be either:

1. On the list of Medicare-approved telemedicine procedure codes applicable for the date of service year.
   1. Covered telemedicine procedure codes must be submitted with place of service 02. The use of telehealth POS 02 certifies that the service meets the telehealth requirements. (CMS14)
   2. The use of modifier GT is optional and no longer required for Moda Health Medicaid claims. POS 02 is sufficient.
   3. The GQ modifier is still required when applicable.
   4. Do not use modifier 95 for Moda Health Medicaid telemedicine services.
   5. Use modifier G0 (G Zero) for telehealth services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke. (MLN17) 
2. On the OHA Behavioral Health fee schedule with modifier GT listed as appropriate. This applies for procedure codes in any Service Type category on the Behavioral Health fee schedule.

Distance sites: Providers may perform telehealth services from their own home, if able and appropriate.

References:

• Oregon Health Plan coverage of telephone/telemedicine/telehealth services
• Providers’ COVID-19 benefit and reimbursement policy frequently asked questions
• Latest notices and updates
• COVID-19 Benefit and Reimbursement Policy (updated January 2021)

Audio-only phone services: “PacificSource will allow services by telephone only if synchronous, two-way video is not available during COVID-19.”

Reimbursement: parity, etc.: “PacificSource reimburses for telehealth services as if the service was done in the clinic setting (for services appropriate for telehealth delivery)”

Waiver of copays, etc.: Telehealth visits for COVID-19 testing and testing-related services will be covered at no cost. All other healthcare needs using telehealth will be paid at your normal benefit level. Costs for telehealth visits using Teladoc will be waived, including general medical and behavioral health through December 31, 2021.

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: COVID-19 related services provided by out of network providers will be paid at the same benefit as in-network benefit.

Billing guidance: “Professional claims for telehealth services should be submitted with a Place of Service code ‘02’ on your claim. Modifier GT is also recognized, but not required. Facility claims for telehealth services should be submitted with a Modifier GT to identify the claim as a telehealth service.”

Distance sites: N/A

Reference:

• Telehealth services during COVID-19 crisis (PDF, 315KB)
• Payment and Coding Policy Alerts—COVID-19 Update (PDF, 756KB)

Audio-only phone services: Yes: “Effective March 6, 2020, through June 30, 2020, or until further notice, Payment Policy 92.0 (Telephone Services) has been updated to show that telephone services may be reported for both new and established patients.”

Reimbursement: parity, etc.: For services with a site of service payment differential billed with location code 02, PHP uses the facility payment rate. Services with a site of service payment differential billed with location code 11 and modifier GT will be paid at the non-facility payment rate.

Waiver of copays, etc.: Cost-sharing waived for COVID-19 related services only through March 31, 2021

Originating/receiving sites: Does not require an originating site during COVID-19 Pandemic.

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: N/A

Billing guidance: Submit telehealth claims with the appropriate CPT code for the professional service provided and location code 02**). Modifiers GT and 95 are not required for services billed with location code 02 and will not affect payment if used. For the duration of emergency provision, location code 11 may be used for specified telehealth services, if billed with modifier GT, regardless of the patient’s location or the provider’s location.

Distance sites: When the physician or practitioner at the distant site is licensed under State law to provide a covered telehealth service (i.e., professional consultation, office and other outpatient visits, individual psychotherapy, or pharmacologic management), then he or she may bill for and receive payment for this service when delivered via a telecommunications system.

Distance sites: N/A

References:

• Novel coronavirus (COVID-19): Stay safe as our communities reopen
• How do providers bill for telehealth visits?

Audio-only phone services: Members may use telehealth to connect remotely, either by phone or video, with in-network providers for services covered under your health plan

Reimbursement: parity, etc.:

• Commercial: Yes, April 1, 2020 through October 18, 2021
• Medicare: Yes, April 6, 2020 through the end of the public health emergency

Waiver of copays, etc.: Waiving member costs of provider visit that results in a COVID-19 test, whether in an office, emergency room, telehealth, or urgent care center during the federal public health emergency, currently scheduled to end October 18, 2021. For members with our Capital BlueCross Virtual Care benefit, we are waiving member fees through December 31, 2021 (may not apply to self-insured)

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only. Members do not need to have Capital BlueCross Virtual Care app benefit.

Billing guidance: Providers must identify the place of service (POS) they would bill had the visit occurred as a face-to-face visit. Providers should not use “02” as POS. They must also identify that it was a telehealth service by including Modifier 95 (Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System).

Distance sites: N/A

References:

• Telemedicine services for Independence commercial members
• Telehealth services for Medicare Advantage members
• Telemedicine Services (issue date July 2, 2021)

Audio-only phone services: A telephone (i.e., audio telecommunication only/telephone call) communication provided to an established patient is only covered for the following services:

• Applied behavior analysis
• Health and behavior assessment and intervention
• Office/outpatient evaluation and management service
• Psychiatric diagnostic evaluation
• Psychotherapy

Reimbursement: parity, etc.: N/A

Waiver of copays, etc.: Any applicable member cost-share will be applied for non-COVID-19 related services. Keystone CHIP members $0 copayment for behavioral health telemedicine visits. Effective January 1, 2021, through December 31, 2021 Medicare Advantage members will have a $5 cost-share for MDLive behavioral health visits and $0 copayment for MDLive PCP visits.

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Subject to out-of-network cost sharing. Medicare Advantage members have out-of-network telemedicine coverage, per the Centers for Medicare and Medicaid Services, through the duration of the PHE. The coverage is not limited to COVID-19 related care. If you don’t have a primary care doctor but have telemedicine benefits, you may be able to contact an MDLIVE physician without cost-sharing.

Billing guidance: Professional providers performing telemedicine services described in this policy must report the appropriate modifier (modifier GT or 95) and place-of-service code 02 (Telehealth) to represent telemedicine services.

Distance sites: N/A

References:

• Solo Provider Telehealth Standards (PDF, 572KB)
• Group Practice Telehealth Standards (PDF, 574KB)
• Telehealth
• COVID-19 Information

Audio-only phone services: If you or your clients are unable to access such a platform, Quest will temporarily allow phone sessions, effective immediately. This will end once the state of emergency has been lifted by the governor.

Reimbursement: parity, etc.: N/A

Waiver of copays, etc.: N/A

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only

Billing guidance: Claims for telemental health should be submitted using a location of 02 and/or the GT modifier.

Distance sites: N/A

References:

• Extended benefits for members
• Provider FAQ (PDF, 21KB)
• UPMC Health Plan: Policy and procedure manual (PDF, 21KB)
• COVID-19 Special Coverage and Payment Policy Benefit Coverage (PDF, 174KB)
• List of Telehealth Services (CMS)

Audio-only phone services: If video capabilities are not accessible, telephonic services are eligible for reimbursement.

Reimbursement: parity, etc.: Not specified

Waiver of copays, etc.: Until August 31, 2021, so long as permitted under applicable state and/or federal COVID-19 emergency declarations and associated guidance, UPMC Health Plan will waive all member cost sharing—including deductibles and copayments—for covered virtual health care visits with in-network providers.* Effective September 1, 2021, members are financially responsible for any telehealth cost shares as shown in their specific plan design unless cost sharing is specifically waived under a separate authority (e.g., FFCRA/CARES Act cost sharing waivers for certain COVID-19 diagnostic services).

Originating/receiving sites: Not specified

Telehealth services approved for new patients: Not specified

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only

Billing guidance: UPMC Health Plan requests that POS 02 or modifier 95 (with any other appropriate POS) be included with all telehealth visits for any UPMC Health Plan member claim to ensure appropriate processing.

Distance sites: Not specified

Additional Information: Quest will not cover sessions over Facebook, Twitch, TikTok or other public facing applications.

References:

• Telemedicine/Telephone Services for Commercial Products—Effective January 1, 2021 (PDF, 176KB)
• Telemedicine/Telephone Services for Medicare Advantage Plans during the Public Health Emergency (PHE)—Effective January 1, 2021 (PDF, 143KB)

Audio-only phone services: during the PHE, some services can be furnished using audio technology only.

Reimbursement: parity, etc.: BCBSRI will reimburse telemedicine or telephone only services/encounters at 100% of the in-office allowable amount for any clinically appropriate, medically necessary covered health service.; “Services must comply with the nonpublic electronic communication requirements defined by CMS and/or as otherwise designated by the State of Rhode Island, which involves both audio and video components.”

Waiver of copays, etc.: “BCBSRI will waive member cost share (e.g. copays and/or deductibles and coinsurance) for BCBSRI members for telemedicine and/or telephone only services. This waiver of cost share does not apply to BlueCard host members/those members of other Blue Cross Blue Shield Plans nationally and BCBSRI employer groups who have opted out of cost share waiver or services by out of network providers.”

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Commercial: In-network only.

Billing guidance: Claims for telemedicine services must be filed with both of the following:

• Place of Service (POS) 02: Telehealth: The location where health services and health related services are provided or received, through telehealth telecommunication technology and
• Modifier 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System Claims for telephone only services must only be filed with:
• Place of Service (POS) 02: Telehealth: The location where health services and health related services are provided or received, through telehealth telecommunication technology

Distance sites: N/A

Additional information: Facebook Live, Twitch, and TikTok, should not be used.

Reference: Updated Interim Telemedicine/Telehealth Payment Policy (COVID-19 Pandemic) (PDF, 170KB)

Audio-only phone services: Yes for all codes listed

Reimbursement: parity, etc.: Yes; Harvard Pilgrim will continue to reimburse for telemedicine, telehealth, and telephone only services consistent with in-person rates until further notice and in accordance with state regulations.

Waiver of copays, etc.: Cost sharing for telemedicine services for conditions other than COVID-19 treatment resumed for commercial members* on October 1, 2020 and Medicare Advantage members on January 1, 2021.

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network providers. Doctor On Demand (for medical and behavioral health) or Optum/United Behavioral Health’s virtual visits platform optional.

Billing guidance: During the COVID-19 pandemic and beginning for dates of service on or after March 6, 2020, Harvard Pilgrim will accept and reimburse for telehealth services when performed via asynchronous or synchronous technology.

• All telemedicine/telehealth must be reported with POS 02 (Telehealth is the location where health services and health related services are provided or received, through a telecommunication system.) Appropriate modifiers will continue to be accepted.
• All telemedicine services may be filed with either modifier GT (via interactive audio and video telecommunications system) or modifier 95 (synchronous telemedicine service rendered via a real-time interactive audio and video telecommunication system) appended to the appropriate code.
• All telehealth services may be filed with either modifier GO (Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke) or modifier GQ (Via asynchronous telecommunications system) appended to the appropriate code.

Distance sites: N/A

Reference: BCBS SC Telehealth Updates

Audio-only phone services: N/A

Reimbursement: parity, etc.: Paid at parity with office visits

Waiver of copays, etc.: N/A

Originating/receiving sites: in-network only

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Providers are required to enroll in the telehealth program prior to rendering services. Although providers no longer require a formal approval of telehealth vendors for reimbursement, they will be asked to confirm if they have a business associate agreement in place with their telehealth vendor. 

Billing guidance: Consulting physicians will submit claims for telemedicine or telepsychiatry services using the appropriate CPT code for the professional service along with the telemedicine modifier GT, via interactive audio and video telecommunications systems (e.g., 99243 GT). By coding and billing the "GT" modifier with a covered telemedicine procedure code, the consulting physician is certifying that the member/beneficiary was present at the referring physician site when the telemedicine service was furnished. Telemedicine services are subject to any coinsurance or copayment requirements.

Distance sites: N/A

Reference:

• Provider FAQ
• BC Tennessee Telehealth Guide (PDF, 988KB)
• BC Tennessee Behavioral Health Telehealth Codes (PDF, 95KB)
• BlueCare Tennessee Telehealth and Telephonic/Audio-Only Services Update (PDF, 106KB)

Audio-only phone services: Yes

Allowed services: Apple, FaceTime, Skype, Zoom, Google Hangouts Meet and other office platforms

Reimbursement: parity, etc.: Same as in-person

Waiver of copays, etc.: If there is a COVID-19 diagnosis, waiving the cost-share for telehealth services performed by network providers. If telehealth is being provided for other conditions, will continue to apply cost-share to members.

Originating/receiving sites: In August 2020, the Tennessee legislature expanded access to telehealth by requiring health insurance companies to reimburse providers an originating site fee that was set by CMS before August 20, 2020. For the purpose of telehealth, the originating site is the patient’s location. For a telehealth visit to be covered under this measure, the patient must have been seen in person by the physician or the health service provider’s practice group within the 16 months prior to the telemedicine visit.

Telehealth services approved for new patients: Yes. You can use E/M codes to bill for telehealth with both new and established patients

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: N/A

Billing guidance: “When billing for telehealth, applicable service codes, diagnostic codes, modifiers, and units should be reported with Place of Service-02 or your normal Place of Service code with a 95 modifier appended to the CPT^®/HCPCS code. This will let us know you’ve treated our member using telehealth.”

Distance sites: N/A

Reference:

• Public Employees Health Plan providers
• Public Employees Health Plan E-Care

Audio-only phone services: Phone visits are possible with virtually any in-network doctor and cost about the same as an E-care visit. If you’re on a traditional plan, phone visits cost $10 per visit. If you’re on an HSA, plan the cost will be less than $50 or $10 after you meet your deductible.

Reimbursement: parity, etc.: Video visits are only available with doctors who are set up to do so and cost about the same as a regular office visit. If you’re on a traditional plan, the cost is the applicable office copay, based on provider type. If you’re on an HSA plan the cost will be 10% less than the regular office visit cost.

Waiver of copays, etc.: N/A

Originating/receiving sites: N/A

Telehealth services approved for new patients: Yes

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: N/A

Billing guidance: EHP covers telehealth visits provided by any of our contracted providers at a rate of 90% of the in-office fee. Telehealth services should be provided with a HIPAA compliant platform and billed with a GT modifier or 02 place of service.

PEHP will be covering the telephone E & M visit codes (99441–99443) now through the coronavirus crisis to assist our members to have access to provides that may not have a telehealth option to communicate with our members.

Distance sites: N/A

References:

• COVID-19 Interim Telehealth Billing/Coding FAQs
• COVID-19 Resources for Providers
• Interim Telehealth Billing Codes Table

Audio-only phone services: Telephonic, digital, and e-CPT codes are reimbursed per the existing plan fee schedule based on the codes specific to those services. However, coding with place of service equivalent to a face-to-face visit offers a higher rate than the traditional “02” place of service during this time frame only for commercial, FEHB, and Medicare plans. Medicaid already pays at a higher rate.

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: N/A

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: N/A

Billing guidance: For commercial, FEHB, and Medicare plans, bill using the CMS 1500 form with the place of service that would be equal to a face-to-face visit. Additionally, append the “95” or “GT” modifier to indicate that the service was performed via telehealth. Note: If billing place of service “02” (Telehealth), claims will be paid but at the lower, existing fee schedule amount. For Medicaid, continue to bill using the CMS 1500 form with the place of service “02” (per Utah state guidance).

Distance sites: N/A

Reference: Temporary COVID-19 Telemedicine Policy (PDF, 39KB)

Audio-only phone services: University of Utah Health Plans covers telephonic visits between participating providers and members at 100% of the member’s benefit for COVID-19 diagnoses (B97.29, U07.1, Z03.818, or Z20.828). Additional services not related to COVID-19, provided via telephonic visits are covered at the standard benefit level. Note: exceptions may apply for self-insured groups. Telephonic visits must be billed with the appropriate CPT and Place of Service (POS) codes: a. CPT codes 99441-99443, 98967-98968 b. POS based on provider’s location (Do not bill with POS 02)

Reimbursement: parity, etc.: University of Utah Health Plans covers video telehealth visits between participating providers and members at 100% of the member’s benefit for COVID-19 diagnoses (B97.29, U07.1, Z03.818, or Z20.828). Visits provided via video telehealth by a participating provider that are not related to COVID-19 are covered at the standard benefit level. Note: exceptions may apply for self-insured groups.

Waiver of copays, etc.: N/A

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-Network Only

Billing guidance: Telehealth video services must be billed with POS 02 or modifier -95

Distance sites: N/A

Additional information: Covered CPTs include all services defined under CMS’ approved list of telehealth services

References:

• COVID-19 Provider Resources
• COVID-19 Updates

Audio-only phone services: On a temporary/emergency basis, BCBSVT will pay for intensive outpatient therapy (IOP) services and psychotherapy services for crisis and group psychotherapy services when: 

• Services are rendered via HIPAA-compliant audio/video telemedicine means or by telephone if audio/video telemedicine is not available.
• When the visit is between a provider and a patient (or parent of a patient under the age of 12).

Reimbursement: parity, etc.: Same as in-person services

Waiver of copays, etc.: Eligible services are subject to applicable member cost sharing such as copayments, coinsurance, and deductible. Member cost sharing under this policy will be the same cost sharing that would apply had the services been delivered in-person. Waiver of cost share for COVID 19 related services through March 31, 2022.

Originating/receiving sites: N/A

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: N/A

Billing guidance: For psychotherapy (for crisis services) and group psychotherapy services, providers should append the appropriate telemedicine modifier (-95 for CPT codes and -GT for HCPCS codes) and bill using place of service 02.

IOP services should be billed in the same way they would have been billed had the services been provided in person. In other words, providers should not append the telemedicine modifiers (-95 or -GT) to the CPT or HCPCS codes associated with IOP services, and providers should not utilize place of service 02 for IOP services.

Distance sites: N/A

Additional information: Only allowed when medically necessary when applicable criteria have been met

Reference: Premera Blue Cross response to COVID-19

Audio-only phone services: N/A

Reimbursement: parity, etc.: Reimbursement consistent with an in-office visit during the public health emergency. HHS announced that the COVID-19 public health emergency (PHE) will likely remain in place for the entirety of 2021. However, a PHE declaration is limited by law to a 90-day period that can be terminated early or extended. Premera will extend federally mandated benefits every 90 days upon official renewal of the PHE by HHS Secretary. The HHS will provide 60-day notice if it decides to terminate PHE or allow it to expire.

Waiver of copays, etc.: Telehealth cost share waivers ended on January 1, 2021. Depending on benefit plan design, the expanded telehealth network continues to be available to members.

Originating/receiving sites: For Medicare patients: CMS has loosened guidelines around telehealth services during the COVID-19 Public Health Emergency. The previous requirement for services to be provided in certain types of originating sites and locations has been waived for the duration of the COVID-19 public health emergency.

Telehealth services approved for new patients: Providers can care for new patients via a telehealth virtual encounter and bill those services using the appropriate CPT that reflects the services rendered, in addition to the telehealth modifier and place of service. Virtual care for an established patient should also be billed with an appropriate CPT, many of which are found in Premera’s payment policy. Note that these services must also be billed using the appropriate telehealth modifier and place of service.

For Medicare, view the CMS list of telehealth services and codes. Bill services either with the place of service in which you ordinarily see patients with a modifier 95 or with place of service of 02 to reflect telehealth.

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: in-network only; Doctor on Demand, Boulder Care, and Workit Health optional

Billing guidance: Premera will be extending the payment of telehealth visits at the in-person allowed amount, during the national public health emergency, beyond September 1, 2020 as previously communicated. For providers who are delivering services via telehealth, Premera will require providers to continue to use the correct telehealth place of service (POS) 02 with the procedure code appended with either modifier 95 or GT. Claims with modifiers indicating they were telehealth, if billed with POS 11, will be rejected up front and will require the correct POS to match the service billed. We will no longer accept POS 11 for telehealth services.

Distance sites: N/A

Reference: Telemedicine Matrix

Audio-only phone services: N/A

Reimbursement: parity, etc.: N/A

Waiver of copays, etc.: N/A

Originating/receiving sites: Effective May 25, 2021, BCBSWY has updated our telemedicine guidance. BCBSWY will permit telephonic and telemedicine visits to occur to the patient’s home. Inpatient telemedicine encounters are permitted within the same facility.

Telehealth services approved for new patients: N/A

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: N/A

Billing guidance: Use standard place of service codes, do not bill POS code 2. Bill modifier GT or 95.

Distance sites: N/A

Additional information: Specific codes not provided