This list of state-based payers provides details on more than 50 of the better-known commercial insurers’ policies for extended telehealth (TH) coverage during the COVID-19 emergency.
Note: Expiration dates are rapidly changing. While we strive to keep the information updated, please check with the insurer directly for current information.
About this list
How created
This listing is the result of the largest ever collaboration between APA Services, Inc. (specifically Practice’s Legal and Regulatory Affairs and Office of Health Care Finance) and the Inter Organizational Practice Committee (IOPC), a group of national neuropsychology groups.
The initial research on scores of state insurers was done by a team of neuropsychology graduate students supervised by IOPC leaders. The information benefited from feedback from the APA-affiliated state psychological associations’ Directors of Professional Affairs and insurance/reimbursement leaders.
How to read the information
The national and regional payer section has listings for national companies like Aetna, Optum, Cigna, and Anthem BCBS, and regional companies that are in multiple states. The state-based listing provides our initial group of companies that are exclusively/primarily in one state (see Focus on commercial insurance below).
In each section, you’ll see
- basic information on the company and web links
- the common behavioral health (BH) procedures/codes covered by the company’s emergency TH policies
- general information on billing, co-pays, out-of-network, etc.
- a list of less common BH procedures/codes covered by those policies
Focus on commercial insurance
These listings focus on commercial insurance but include some specific information on variations for other programs like Medicaid and Medicare Advantage. Within commercial insurance, a company’s TH policies do not necessarily apply to the large portion of self-insured plans of large companies; those plans (known as ERISA plans) are administered but not controlled by the insurance companies.
For more information, see and APA Service’s FAQs practicing psychologists have about COVID-19 (see 6th FAQ regarding ERISA plans):
We are evaluating whether to expand the listings to include Medicaid MCOs and Medicare Advantage plans, although it appears that those companies are primarily driven by directives from state Medicaid agencies and CMS respectively.
The listings are a work in progress
Developing these listings was made challenging not only by the scope and complexity of so many companies’ TH policies, but also by the fact that they are constantly changing. Some larger companies update them very frequently.
We are still finalizing our analysis of several single state companies (e.g., BCBS companies in Alabama, Arkansas, Louisiana, and two in New York) that will be added to the state chart.
We will update the charts periodically, more frequently for major companies. Please email us with significant updates or corrections.
End dates
Most companies are either constantly extending the end dates for their TH policies as they approach or planning to end their policies when the federal or state government declares the emergency over. While most states are in early stages of reopening, many of their public health emergency (PHE) orders are likely to stay in place as long as there is some level of COVID-19 restrictions, e.g., prohibitions on mass gatherings. (A few states’ PHE orders have already expired, and some are set to expire later this summer.)
APA Services is advocating on multiple fronts for payers to keep their TH policies in place for at least 12 months after the federal emergency declaration ends. It is also advocating for payers to permanently adopt appropriate extensions of their TH policies when the crisis is over.
Disclaimer
We prepared this page to provide information to psychologists in this rapidly changing landscape. Because the law and related information continually change, we will strive to update the page weekly, so note the date stamp. Please email us with any updates.
Please note this document does not constitute legal advice. APA cannot guarantee the completeness or accuracy of this document, and we recommend that psychologists independently verify this information (partly by using the hyperlinks included) and consult with counsel in their state with appropriate experience before relying on or making decisions based on this information.
Alaska
Premera Blue Cross
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: extended through December 31, 2020
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. This change is in effect through June 30, 2020, per CMS guidance.
Waiver of copays, etc.: If a telehealth provider charges you a copay, deductible, or coinsurance for telehealth services through June 30, 2020, Premera will reimburse when the claim is processed.
Originating/receiving sites: N/A
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 code 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: N/A
Billing guidance: Premera is following CMS guidance on telehealth payments during the COVID-19 health crisis. Providers who normally bill POS 11 for a patient in-office visit should continue to use POS 11 for telehealth visits and the procedure code appended with either modifier 95 or GT (GT can’t be used for a Medicare claim).
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
For Premera-contracted providers, your current contract covers telehealth services if the care provided is appropriate within the scope of the provider’s licensure |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
N/A |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
N/A |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
N/A |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
N/A |
|
E-visit Services (G2061, G2062, G2063) |
N/A |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
N/A |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
Arizona
Arizona BCBS
Type of plan: Commercial and Medicaid/Medicare
Coverage dates: N/A
Reference: Blue Cross® Blue Shield® of Arizona (BCBSAZ) tele-everything quick reference guide (PDF, 486KB)
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.: N/A
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)
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 audio/video telemedicine services, use 95 or GT (for Medicare Advantage you must use 95). For commercial professional claims and Medicare Advantage facility claims, use place of service (POS) 02. For Medicare Advantage professional claims, the POS should be the same as if the patient was seen in the office. Virtual check in: bill with G2010 or G2012. E-visit: Bill with 99421-99423; G2061-G2063.
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Appears as though all telehealth services are covered so long as they are already covered by the member’s specific insurance plan |
|
Group Psychotherapy (90853, 90849) |
All normal covered codes covered via telehealth |
|
Family Psychotherapy (90846, 90847) |
|
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
|
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
|
|
Psychological Evaluation (96130, 96131) |
|
|
Neuropsychological Evaluation (96132, 96133) |
|
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
|
|
Neurobehavioral Status Exam (96116, 96121) |
|
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
All normal covered codes covered via telehealth |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
California
Blue Shield of California
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: N/A
Reference: Telehealth and other virtual care (PDF, 192KB)
Audio-only phone services: Providers may use non-public 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.: Not clear for care beyond testing and treatment of COVID-19. But cost-sharing for all calls to Teladoc, from March 1, 2020 through May 31, 2020, regardless of whether they are specifically related to COVID-19.
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: Yes, according to contact from IOPC researcher to a Blue Shield rep April 18, 2020
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
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
The telehealth services provided during the COVID-19 public health emergency do not have to be related to a patient’s diagnosis or treatment for COVID-19. This exception applies to all telehealth services, including behavioral health. |
|
Group Psychotherapy (90853, 90849) |
|
|
Family Psychotherapy (90846, 90847) |
|
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
|
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
|
|
Psychological Evaluation (96130, 96131) |
|
|
Neuropsychological Evaluation (96132, 96133) |
|
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
|
|
Neurobehavioral Status Exam (96116, 96121) |
|
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
The telehealth services provided during the COVID-19 public health emergency do not have to be related to a patient’s diagnosis or treatment for COVID-19. This exception applies to all telehealth services, including behavioral health. |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
Connecticut
ConnectiCare
Type of plan: Commercial/Medicaid
Coverage dates: March 1, 2020–June 30, 2020
References:
- 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)
Audio-only phone services: 98966-98968
Reimbursement: parity, etc.: Yes
Waiver of copays, etc.: No. Cost-sharing through June 30, 2020 (plan-based)
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
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837, 90845 |
|
Group Psychotherapy (90853, 90849) |
90853 |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
96156, 96159,96164, 96165, 96167, 96170, 9617 |
|
Psychological Evaluation (96130, 96131) |
Yes |
|
Neuropsychological Evaluation (96132, 96133) |
Yes |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Yes |
|
Neurobehavioral Status Exam (96116, 96121) |
Yes |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
Yes |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
96130 |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
Yes |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
Yes |
|
E-visit Services (G2061, G2062, G2063) |
Yes |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
98966, 98967, 98968 |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
Yes |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
G0396, G0397 |
Florida
Florida BCBS
Type of plan: Commerical, Medicaid
Coverage dates: Updated May 28, 2020 but no stated end date. Company claims that guidance will be updated frequently.
Reference: COVID-19 provider information
Audio-only phone services: If video isn’t available it is allowed for CMS and Florida Blue clients. The State Group will not cover audio-only virtual visits.
Reimbursement: parity, etc.: N/A
Waiver of copays, etc.: $0 cost share for State Group members. Not clear for other members
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: Use GT or 95 modifiers
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837 |
|
Group Psychotherapy (90853, 90849) |
Yes |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
96156, 96158 |
|
Psychological Evaluation (96130, 96131) |
Yes |
|
Neuropsychological Evaluation (96132, 96133) |
Yes |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Yes |
|
Neurobehavioral Status Exam (96116, 96121) |
96121 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
Yes |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
0373T |
|
E-visit Services (G2061, G2062, G2063) |
Yes |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
N/A |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
Georgia
Ambetter
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: March 17, 2020–June 30, 2020
References:
- Ambetter from Peach State Health Plan covered services and authorization guidelines (PDF, 1.25MB)
- Coronavirus guidance
Audio-only phone services: Unclear
Reimbursement: parity, etc.: Same as in-person
Waiver of copays, etc.: Ambetter members can have a telehealth visit with a provider at no cost to the member. At this time, this also applies to members enrolled in health savings account-eligible high deductible health plans (HDHPs.).
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: N/A
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes |
|
Group Psychotherapy (90853, 90849) |
Yes |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
“Health and behavior Assessment” with code 96150 covered. No other codes listed |
|
Psychological Evaluation (96130, 96131) |
Not clear |
|
Neuropsychological Evaluation (96132, 96133) |
Not clear but likely covered given that NP test admin and scoring is covered |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
96101, 96102, 96103, 96105, 96110, 96111, 96116, 96118, 96119, 96120, 96125 |
|
Neurobehavioral Status Exam (96116, 96121) |
96116 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
96110 |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
96125 |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
0362T |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
0373T |
|
E-visit Services (G2061, G2062, G2063) |
Codes not listed as covered |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
No |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
No |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
No |
Idaho
Blue Cross of Idaho
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: N/A
References:
Audio-only phone services: N/A
Reimbursement: parity, etc.: N/A
Waiver of copays, etc.: “Our members will pay nothing out of pocket—no copays, deductibles, or coinsurance—for telehealth visits with an in-network provider until July 31, 2020.”
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
Billing guidance: Telehealth services must be submitted with a Place of Service “02” on a CMS-1500 (837P) claim.
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
N/A |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
N/A |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
N/A |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
Yes |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
Yes |
|
E-visit Services (G2061, G2062, G2063) |
N/A |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Yes |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
Kansas
BCBS Kansas
Type of plan: Commercial
Coverage dates: 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.: Visits to providers that can be performed virtually will be paid at the same rate as an in-person office visit as long as the service is medically necessary, meets the criteria listed below, and occurs on or after March 16, 2020 during the temporary period.
Waiver of copays, etc.: No member cost-share
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: BCBS Kansas members can also contact American Well as a virtual care benefit.
Billing guidance: N/A
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Covering services “reasonably provided” via telehealth |
|
Group Psychotherapy (90853, 90849) |
|
|
Family Psychotherapy (90846, 90847) |
|
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
|
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
|
|
Psychological Evaluation (96130, 96131) |
|
|
Neuropsychological Evaluation (96132, 96133) |
|
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
|
|
Neurobehavioral Status Exam (96116, 96121) |
|
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
Covering services “reasonably provided” via telehealth |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
N/A |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Yes. To be eligible for coverage, it must be medically reasonable for such services to be provided using real-time, two-way audio and or audio/visual communications. These services should be billed to BCBS Kansas with Revenue Code 0780 to ensure no member cost share will be applied. |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
Massachusetts
BCBS of Massachusetts
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: N/A
References:
- Medical policy: Neuropsychological and psychological testing (PDF, 192KB)
- Telehealth (telemedicine)—behavioral health payment policy (PDF, 110KB)
Audio-only phone services: For all covered CPT codes
Reimbursement: parity, etc.: Same as in-person
Waiver of copays, etc.: Member cost is according to the benefit plan chosen by the employer: Fully insured accounts are the same as the equivalent in-office visit. If there is a split copayment benefit, the lesser of the two will apply. Self-insured accounts may set a unique cost share for telehealth, although Blue Cross recommends that it be equivalent to an in-office visit.
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: N/A
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837 (Requires modifier 95 or GT) |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
N/A |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
Yes |
|
Neuropsychological Evaluation (96132, 96133) |
Yes |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Yes |
|
Neurobehavioral Status Exam (96116, 96121) |
N/A |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
N/A |
|
E-visit Services (G2061, G2062, G2063) |
Yes |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
98966, 98967, 98968 |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
Tufts Health Plan
Type of plan: Commercial
Coverage dates: effective for dates of service March 6, 2020 until July 20, 2020 (if necessary, date may be extended again)
References:
- Coronavirus (COVID-19) updates for providers
- Coronavirus update: Information about access to health care services in response to the COVID-19 outbreak
Audio-only phone services: The use of audio without video is acceptable.
Reimbursement: parity, etc.: N/A
Waiver of copays, etc.: Waiving member cost shares for telehealth behavioral health—including copayments, coinsurance, and deductibles. This coverage applies at in-network providers and at out-of-network providers in the event a member cannot easily find an in-network provider to provide timely 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: Providers do not need to use Teladoc to provide services to our members. Teladoc is an additional benefit available to commercial members.
Billing guidance: N/A
Distance sites: N/A
Additional information: Prior authorization and notification is not required for the following services:
- Applied Behavioral Analysis (ABA) for all products
- Behavioral Health for Children and Adolescents (BHCA) for Massachusetts commercial products
- Children’s Behavioral Health Initiative (CBHI) for Tufts Health Together
- 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.
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Contracting providers may provide telemedicine services for all behavioral health |
|
Group Psychotherapy (90853, 90849) |
90853 |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
Yes |
|
Psychological Evaluation (96130, 96131) |
Yes |
|
Neuropsychological Evaluation (96132, 96133) |
Yes |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Yes |
|
Neurobehavioral Status Exam (96116, 96121) |
Yes |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
96110: Network Health will pay for behavioral health screening tools administered and scored in accordance with the EPSDT Periodicity Schedule separately from, and in addition to, the rate for the periodic or interperiodic EPSDT and PPHSD visits. Claims for the behavioral health screening tool must be submitted using Current Procedural Terminology (CPT) service code 96110. |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
97129, 97130 |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
Yes |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
Yes |
|
E-visit Services (G2061, G2062, G2063) |
No |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
No |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
No |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
Unclear |
Michigan
BCBS of Michigan
Type of plan: Commercial, Medicare Plus, and BCN Advantage
Coverage dates: N/A
References:
- Telehealth for behavioral health providers (PDF, 334KB)
- Telehealth procedure codes for COVID-19 (PDF, 169KB)
- Michigan telemedicine policy, simplified
Audio-only phone services: For all services for which telemedicine is payable with place of service code 02
Reimbursement: parity, etc.: Eligible providers bill same as face-to-face visit
Waiver of copays, etc.:
Commercial: Through June 30, 2020, waiving cost share for the most common behavioral health services when delivered via telehealth for Blue Cross and Blue Care Network (BCN) commercial members.
Medicare and BCN Advantage: Through December 3, 2020, waiving cost share for the most common behavioral health services delivered via telehealth for Medicare Plus BlueSM and BCN AdvantageSM members. Some self-funded groups are still making decisions on this waiver; watch for a web-DENIS message with more information.
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.
Distance sites: Not specified
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837 |
|
Group Psychotherapy (90853, 90849) |
Yes |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
96158, 96170, 96171 |
|
Psychological Evaluation (96130, 96131) |
96130, 96131 |
|
Neuropsychological Evaluation (96132, 96133) |
96132, 96133 |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Yes |
|
Neurobehavioral Status Exam (96116, 96121) |
Yes |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
Yes |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
96130 |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
Yes |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
Yes |
|
E-visit Services (G2061, G2062, G2063) |
Yes |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Yes (POS-2-Telehealth required, modifier not required) |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
G0396, G0397 |
Priority Health
Type of plan: Commercial
Coverage dates: Effective March 26, 2020 through June 30, 2020, will temporarily allow credentialed providers to bill routine practice codes for services provided through telehealth. Other policies have different effective dates.
References:
Audio-only phone services: Yes, 98966-98968, 99446, 99447, 99449
Reimbursement: parity, etc.: Yes, from May 1, 2020 through June 30, 2020 paying the same rate for telehealth as for in-person visits
Waiver of copays, etc.: Covering the cost of virtual care for most members for virtual visit code: 99441-99443, 99421-99423, and 98970-98972, March 19, 2020 through June 30, 2020. Other codes billed as telehealth will have the member’s normal cost share. March 19, 2020 through June 30, 2020 waiver of cost share for Medicare Advantage members.
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: “From May 1, 2020–June 30, 2020: We’re paying the same rate for telehealth as for in-person visits. From March 26, 2020–April 30, 2020: paying at the standard facility-based rate when billed with a Place of Service 02. Starting May 1, 2020, follow the same process used by CMS to bill for telehealth services. Bill with the place of service you’d normally use for in-person visits. Add the 95 modifier to identify the visit as telehealth. For Medicaid members, continue to use the GT modifier.”
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837 |
|
Group Psychotherapy (90853, 90849) |
90853 |
|
Family Psychotherapy (90846, 90847) |
90846, 90847 |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
90839, 90840, 90785 |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
96130, 96131 |
|
Neuropsychological Evaluation (96132, 96133) |
96132, 96133 |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
96136, 96137, 96138, 96139 |
|
Neurobehavioral Status Exam (96116, 96121) |
96116, 96121 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
97151 |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
97153, 97154, 97155, 97156 |
|
E-visit Services (G2061, G2062, G2063) |
G2061, G2062, G2063 |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
98966, 98967, 98968 |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
99446, 99447, 99449 |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
Minnesota
BCBS Minnesota
Type of plan: Commercial and Medicaid
Coverage dates: Extended telehealth policy effective the duration of the national public health emergency related to COVID-19
Reference: Reimbursement Policy: Televideo consultations/telehealth/telemedicine services (PDF, 204KB)
Audio-only phone services: Telehealth may be provided over the phone
Reimbursement: parity, etc.: N/A
Waiver of copays, etc.: “We’re covering the cost of virtual care for most members for virtual visit codes: 99441-99443, 99421-99423, and 98970-98972, starting March 19, 2020 through June 30, 2020.”
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: N/A
Distance sites: N/A
Additional information: Telehealth may be provided over a non-HIPAA compliant audio-visual application, such as Skype or FaceTime
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes |
|
Group Psychotherapy (90853, 90849) |
Yes |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
96156, 96158, 96159, 96164, 96165, 96167, 96170, and 96171 |
|
Psychological Evaluation (96130, 96131) |
Yes |
|
Neuropsychological Evaluation (96132, 96133) |
Yes |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Yes |
|
Neurobehavioral Status Exam (96116, 96121) |
96121 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
96127 |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
97129, 97130 |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
97151, 97152 |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
97153, 97154, 97155, 97156, 97157, 97158 |
|
E-visit Services (G2061, G2062, G2063) |
No |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
N/A |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
No |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
Yes |
Missouri
BCBS of Kansas City
Type of plan: Commercial, Medicare, and Self Insured
Coverage dates: extended to July 25, 2020
References:
Audio-only phone services: Behavioral health provider telephonic (call) therapy visits. In order for the allowable to be the same as an in-person therapy visit, you must use the in-person therapy visit code and place of service 02 for telehealth. These therapy visits would be at no member cost share.
Reimbursement: parity, etc.: Yes, with POS 02
Waiver of copays, etc.: Other codes billed as telehealth will have the member’s normal cost share.
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: According to representatives, “telehealth office offering no member cost sharing covered at 100% for any mental health diagnosis. This is to remain until July 25, 2020. Codes vary but the main key is to document the POS02 place of service. Video and audio are both covered. No changes to reimbursement.”
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837, 90845 |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
90846, 90847 |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
90839, 90840, 90785 |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
96156, 96158, 96159, 96164, 96165, 96167, 96168 |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
96116 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
97155, 97156, 97157 |
|
E-visit Services (G2061, G2062, G2063) |
Yes |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
N/A |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
G0396, G0397 |
Nebraska
BCBS Nebraska
Type of plan: Commercial
Coverage dates: March 13, 2020–June 30, 2020
Reference: General policies and procedures manual (PDF, 2MB)
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.: 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: N/A
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
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837 |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
N/A |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
90839 |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
|
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
|
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
New Hampshire
Tufts
Type of plan: Commercial and Medicare/Medicaid
Telehealth services approved for new patients: Yes
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
COVID telehealth changes effective through July 20, 2020 |
|
Group Psychotherapy (90853, 90849) |
All normal covered codes covered via telehealth |
|
Family Psychotherapy (90846, 90847) |
All normal covered codes covered via telehealth |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
All normal covered codes covered via telehealth |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
N/A |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
New Jersey
Horizon BCBS
Type of plan: Commercial
Coverage dates: N/A
References:
- Telemedicine services
- Commercial and ASO existing and extended telemedicine policy codes (PDF, 2.5MB)
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.: “Eliminating member cost sharing for services provided through telemedicine. Horizon BCBSNJ has waived all deductibles, copays, and coinsurance for in-network behavioral health services delivered through telemedicine.”
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 for telehealth
Billing guidance: Billing with 95 or GT modifiers
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes |
|
Group Psychotherapy (90853, 90849) |
Does not appear to be covered |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
96156, 96158, 96159 |
|
Psychological Evaluation (96130, 96131) |
Does not appear to be covered |
|
Neuropsychological Evaluation (96132, 96133) |
Does not appear to be covered |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Does not appear to be covered |
|
Neurobehavioral Status Exam (96116, 96121) |
96116 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
Does not appear to be covered |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
97129, 97130 |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
97151, 97152 |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
97153, 97154, 97155, 97156, 97157 |
|
E-visit Services (G2061, G2062, G2063) |
Yes |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Yes |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
Does not appear to be covered |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
G0396, G0397 |
New Mexico
New Mexico Health Connections
Type of plan: Insurance exchange and commercial
Coverage dates: N/A
Reference: Member support during the coronavirus
Audio-only phone services: N/A
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: Doesn’t specify but seems unlikely
Billing guidance: Billing to be done as normally would be if services were in-person
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
We support the rule by the New Mexico Medical Board to treat members remotely through electronic means (phone, text, internet, email) in order to minimize direct contact during the COVID-19 outbreak. Those visits should be billed as regular patient visits and will be treated as such by New Mexico Health Connections. This is all the information openly given to providers for what services are specifically covered. |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
All normal covered codes covered via telehealth |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
|
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
|
|
Psychological Evaluation (96130, 96131) |
|
|
Neuropsychological Evaluation (96132, 96133) |
|
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
|
|
Neurobehavioral Status Exam (96116, 96121) |
|
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
All normal covered codes covered via telehealth |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
Presbyterian Health Plan (AKA Centennial Care)
Type of plan: Commercial, Medicaid, Medicare Advantage
Coverage dates: N/A
Audio-only phone services: Allowed
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: N/A
Billing guidance: N/A
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837 |
|
Group Psychotherapy (90853, 90849) |
90853, 90849 |
|
Family Psychotherapy (90846, 90847) |
90846, 90847 |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
90839, 90840, 90785 |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
|
|
Neuropsychological Evaluation (96132, 96133) |
|
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
|
|
Neurobehavioral Status Exam (96116, 96121) |
|
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
97151, 97152, 0362 |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
97153, 97154, 97155, 97156, 0373 |
|
E-visit Services (G2061, G2062, G2063) |
N/A |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
True Health New Mexico
Type of plan: Appears to be both commercial and Medicare/Medicaid
Reference: COVID-19 coronavirus information for providers (PDF, 168KB)
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
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Follows CMS. All telehealth services are covered for services that are medically necessary. |
|
Group Psychotherapy (90853, 90849) |
All normal covered codes covered via telehealth |
|
Family Psychotherapy (90846, 90847) |
|
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
|
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
|
|
Psychological Evaluation (96130, 96131) |
|
|
Neuropsychological Evaluation (96132, 96133) |
|
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
|
|
Neurobehavioral Status Exam (96116, 96121) |
|
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
All normal covered codes covered via telehealth |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
New York
Excellus BCBS
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: 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 reimburse all telehealth visits at the same rate as in-person visits for the same CPT code, and we will use the higher non-facility (office) relative value units for dates of service from March 13, 2020 until the state of emergency has been lifted.”
Waiver of copays, etc.: In-network telehealth visits will be covered with no member cost-share when the services would have been covered under the member’s policy if delivered in-person, including behavioral health treatment.
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 (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes |
|
Group Psychotherapy (90853, 90849) |
90853 |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
Does not appear to be covered/not found |
|
Psychological Evaluation (96130, 96131) |
Yes |
|
Neuropsychological Evaluation (96132, 96133) |
Yes |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Yes |
|
Neurobehavioral Status Exam (96116, 96121) |
Yes |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
N/A |
|
E-visit Services (G2061, G2062, G2063) |
Yes |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Yes |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
Group Health Incorporated (AKA Emblem Health)
Type of plan: Commercial and Medicare
Coverage dates: N/A
References:
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.: Your virtual telehealth visit (in-network only) will be covered by your plan. There will be no cost-sharing, including copays, coinsurance, or deductibles. Virtual visits include video and/or phone 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: In-network only
Billing guidance: Using GT and CR modifiers
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes |
|
Group Psychotherapy (90853, 90849) |
90853 |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
96156, 96159, 96164, 96165, 96167, 96168 |
|
Psychological Evaluation (96130, 96131) |
Yes |
|
Neuropsychological Evaluation (96132, 96133) |
Yes |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Yes |
|
Neurobehavioral Status Exam (96116, 96121) |
96116 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
Does not appear to be covered |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
Does not appear to be covered |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
Does not appear to be covered |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
Does not appear to be covered |
|
E-visit Services (G2061, G2062, G2063) |
Yes for Medicare only |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Yes |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
Yes |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
G0396, G0397 for Medicare only |
North Carolina
BCBS North Carolina
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: 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
Audio-only phone services: Yes, but does not say specifically what services are audio only
Reimbursement: parity, etc.: Paid at parity with office
Waiver of copays, etc.: Copays have been waived.
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: Some coverage outside of state.
Billing guidance: Use any CPT code you would use for face-to-face. POS 02. Phone only requires modifier CR.
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837, 90845 |
|
Group Psychotherapy (90853, 90849) |
90853 |
|
Family Psychotherapy (90846, 90847) |
N/A |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
90839, 90840 |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
N/A |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
N/A |
|
E-visit Services (G2061, G2062, G2063) |
N/A |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Medicare: Yes, follow CMS guidelines
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
North Dakota
BCBS North Dakota
Type of plan: Commercial
Coverage dates: N/A
Reference: Billing and coding guidelines during COVID-19
Audio-only phone services: N/A
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: N/A
Billing guidance: Bill appropriate code for services rendered. POS 02. Modifier 95
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
N/A |
|
Group Psychotherapy (90853, 90849) |
|
|
Family Psychotherapy (90846, 90847) |
|
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
|
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
|
|
Psychological Evaluation (96130, 96131) |
|
|
Neuropsychological Evaluation (96132, 96133) |
|
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
|
|
Neurobehavioral Status Exam (96116, 96121) |
|
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
Ohio
Medical Mutual
Type of plan: Commercial and Medicare Advantage
Coverage dates: until emergency order is lifted by the U.S. Deptartment of Health and Human Services
Reference: COVID-19 frequently asked questions for providers (PDF, 268KB)
Audio-only phone services: Yes, for all codes listed
Reimbursement: parity, etc.: Payment for the service would be considered payment in full. There is no additional reimbursement provided for the technology cost
Waiver of copays, etc.: Copays are being waived for all Medical Mutual fully insured and self-funded customers. This also covers the cost of the provider visit, which could include a telehealth (telemedicine) visit, urgent care, or emergency room visit, to determine whether the COVID-19 testing is required and to administer the test.
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: 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.
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
90785 |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
96116 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
97151 |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
97153, 97155, 97156 |
|
E-visit Services (G2061, G2062, G2063) |
Yes |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Yes |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
G0396, G0397 |
Oregon
Moda
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: N/A
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)
Audio-only phone services:
- For commercial: “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”
- For Medicaid: “Telehealth visits can be provided by telephone when appropriate during the COVID-19 crisis. The requirement for synchronous visits with both audio and video capability is temporarily waived.”
- For Medicare: “Telephones that have audio and video capabilities may be used for telehealth.”
Reimbursement: parity, etc.: N/A
Waiver of copays, etc.: N/A
Originating/receiving sites: N/A
Telehealth services approved for new patients: Only e-visits listed
Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: N/A
Billing guidance: Use POS 02. Modifier 95 is optional.
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
For commercial: Yes |
|
Group Psychotherapy (90853, 90849) |
For commercial: Yes |
|
Family Psychotherapy (90846, 90847) |
For commercial: Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
For commercial: Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
For commercial: No |
|
Psychological Evaluation (96130, 96131) |
For commercial: Yes |
|
Neuropsychological Evaluation (96132, 96133) |
For commercial: Yes |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
For commercial: Yes |
|
Neurobehavioral Status Exam (96116, 96121) |
For commercial: 96116 only |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
For commercial: 96127 only |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
For commercial: 96125 only |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
For commercial: 97151-97158 only |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
For commercial: 97151-97158 only |
|
E-visit Services (G2061, G2062, G2063) |
For commercial: Yes |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
For commercial: Yes |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
For commercial: Yes |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
For commercial: G0396, G0397 only |
PacificSource
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: N/A
References:
- Oregon Health Plan coverage of telephone/telemedicine/telehealth services
- Providers’ COVID-19 benefit and reimbursement policy frequently asked questions
- Latest notices and updates
Audio-only phone services: Defines telephone only in same language as telehealth
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.: 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: “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
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
General: “PacificSource has expanded coverage to allow the following provider types to bill appropriate evaluation and management type services that can be performed in real time via telehealth” lists clinical psychologists as providers Medicaid/Medicare: “psychotherapy and mental health assessments” are covered |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
N/A |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
N/A |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
N/A |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
General: “PacificSource has expanded coverage to allow the following provider types to bill appropriate evaluation and management type services that can be performed in real time via telehealth” lists clinical psychologists as providers Medicaid/Medicare: “psychotherapy and mental health assessments” are covered |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
Providence Health Plan
Type of plan: Commercial
Coverage dates: N/A
Reference: Telehealth services during COVID-19 crisis (PDF, 315KB)
Audio-only phone services: No—“For PHP payment to occur, interactive audio and video telecommunications must be used, permitting real-time communication between the distant site physician or practitioner and the PHP member. As a condition of payment, the patient must be present and participating in the telehealth visit.”
Reimbursement: parity, etc.: “PHP uses the facility payment rate for services furnished via telehealth (except as noted...)”
Waiver of copays, etc.: N/A
Originating/receiving sites: PHP does not distinguish between originating sites that are rural or urban in providing coverage for telehealth services.
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 (telehealth). Modifiers GT and 95 are not required for services billed with location 02 and will not affect payment if used.”
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes |
|
Group Psychotherapy (90853, 90849) |
No, only opioid based group psychotherapy G2086, G2087, and G2088 |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
Yes |
|
Psychological Evaluation (96130, 96131) |
No |
|
Neuropsychological Evaluation (96132, 96133) |
No |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
No |
|
Neurobehavioral Status Exam (96116, 96121) |
96116 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
No |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
G0396, G0397 |
Pennsylvania
Capital Blue Cross
Type of plan: Commercial/Medicare Advantage
Coverage dates: through June 30, 2020
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 June 30, 2020
- Medicare: Yes, April 6, 2020 through the end of the public health emergency
Waiver of copays, etc.: Waiving member fees through June 15, 2020 for medical, psychiatry, and counseling visits using Virtual Care app.
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: 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
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Capital BlueCross is temporarily adjusting our policy to allow providers (identified in the policy) to bill and receive reimbursement consistent with an in-person visit. |
|
Group Psychotherapy (90853, 90849) |
|
|
Family Psychotherapy (90846, 90847) |
|
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
|
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
|
|
Psychological Evaluation (96130, 96131) |
|
|
Neuropsychological Evaluation (96132, 96133) |
|
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
|
|
Neurobehavioral Status Exam (96116, 96121) |
|
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
Capital BlueCross is temporarily adjusting our policy to allow providers (identified in the policy) to bill and receive reimbursement consistent with an in-person visit. |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
Independence BCBS
Type of plan: Commercial/Medicare
Coverage dates: Commercial telemedicine services are effective March 6, 2020 through December 31, 2020; Medicare Advantage telemedicine services are effective March 6, 2020, and for the duration of the public health emergency.
References:
- Telemedicine services for Independence commercial members
- Telehealth services for Medicare Advantage members
Audio-only phone services: N/A
Reimbursement: parity, etc.: N/A
Waiver of copays, etc.: One website says cost-sharing waived, another says cost-sharing will apply based on your health plan (especially for specialist 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
Billing guidance: Modifiers Gt or 95 POS 02 for audio/video, not phone only
Distance sites: N/A
| Services (CPT codes) | Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes |
|
Group Psychotherapy (90853, 90849) |
Yes |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
Yes |
|
Psychological Evaluation (96130, 96131) |
Yes |
|
Neuropsychological Evaluation (96132, 96133) |
Yes |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Yes |
|
Neurobehavioral Status Exam (96116, 96121) |
Yes |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
Yes |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
Yes |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
97151 |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
97153, 97154, 97155, 97156, 97157, 97158 |
|
E-visit Services (G2061, G2062, G2063) |
Yes |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Yes |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
Services do not appear to be covered |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
G0396, G0397 |
Quest
Coverage dates: during the state of emergency
References:
Audio-only phone services: If the telemental health platform is inaccessible, Quest will temporarily allow phone sessions until this state of emergency has been lifted by Governor Tom Wolf of Pennsylvania.
Reimbursement: parity, etc.: Not specified
Waiver of copays, etc.: Not specified
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: Claims for telemental health should be submitted using a location of 02 and/or the GT modifier.
Distance sites: Not specified
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837 |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
96116 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
N/A |
|
E-visit Services (G2061, G2062, G2063) |
N/A |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
N/A |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
UPMC Health Enterprise
Type of plan: Commercial and Medicaid/Medicare
Coverage dates: September 30, 2020
References:
- Extended benefits for members
- Provider FAQ (PDF, 21KB)
- UPMC Health Plan: Policy and procedure manual (PDF, 21KB)
- COVID-19 special coverage and payment pPolicy (PDF, 21KB)
Audio-only phone services: Behavioral health services that are provided by telephone (without a video component) will be eligible for reimbursement for the duration of Pennsylvania’s emergency declaration
Reimbursement: parity, etc.: Not specified
Waiver of copays, etc.: Cost share waived for in-network providers until September 30, 2020
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
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes |
|
Group Psychotherapy (90853, 90849) |
90853 |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
96156, 96158, 96159, 96164, 96165, 96167, 96170, 96171 |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
96116, 96121 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
97151, 97152 |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
97153, 97155, 97154, 97156, 97157, 96158 |
|
E-visit Services (G2061, G2062, G2063) |
Yes |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
N/A |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
Yes |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
Yes |
Rhode Island
BCBS Rhode Island
Type of plan: Commercial and Medicare
Coverage dates: extended through July 31, 2020
Audio-only phone services: N/A
Reimbursement: parity, etc.: “BCBSRI will reimburse telemedicine/telehealth or telephone only encounters at 100% of the in-office allowable amount for any clinically appropriate, medically necessary covered health service.”
Waiver of copays, etc.: “BCBSRI will temporarily waive cost-share (e.g. co-pays and/or deductibles and co-insurance) for services provided by any provider type listed in this policy that would typically be performed in the office setting and that are clinically appropriate and reasonable to provide via telemedicine/telephone.”
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: “Place of Service (POS) 02:” modifer to highlight telehealth. “BCBSRI requires the CR modifier to be added to all claims for Telemedicine/Telehealth or Telephone services, in addition to any modifier that providers would normally file on a claim e.g. GT, GN, GO, GP etc.”
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
No specific codes posted but “BCBSRI will temporarily allow for all clinically appropriate, medically necessary covered health services to be provided through telemedicine/telephone for all/any health conditions in an effort to reduce the need for in-person treatment and support social distancing efforts, as well as to ensure that providers are able to continue to provide medically necessary and clinically appropriate care during the course of this public health emergency. (For example, a chiropractor may not bill for manual manipulation services via telemedicine/telephone or a physical therapist may not bill for manual therapy services.) This includes all behavioral health outpatient facility-based services including but not limited to early intervention, home and community based services, applied behavioral analysis, medication assisted treatment services, crisis intervention services, partial hospital programs, and intensive outpatient programs. This is not applicable to behavioral health inpatient and residential treatment services.” |
|
Group Psychotherapy (90853, 90849) |
|
|
Family Psychotherapy (90846, 90847) |
|
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
|
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
|
|
Psychological Evaluation (96130, 96131) |
|
|
Neuropsychological Evaluation (96132, 96133) |
|
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
|
|
Neurobehavioral Status Exam (96116, 96121) |
|
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
No specific codes posted but “BCBSRI will temporarily allow for all clinically appropriate, medically necessary covered health services to be provided through telemedicine/telephone for all/any health conditions in an effort to reduce the need for in-person treatment and support social distancing efforts, as well as to ensure that providers are able to continue to provide medically necessary and clinically appropriate care during the course of this public health emergency. (For example, a chiropractor may not bill for manual manipulation services via telemedicine/telephone or a physical therapist may not bill for manual therapy services.) This includes all behavioral health outpatient facility-based services including but not limited to early intervention, home and community based services, applied behavioral analysis, medication assisted treatment services, crisis intervention services, partial hospital programs, and intensive outpatient programs. This is not applicable to behavioral health inpatient and residential treatment services.” |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
Harvard Pilgrim
Type of plan:
Coverage dates: N/A
Reference: Interim telemedicine/telehealth payment policy (COVID-19 pandemic) (PDF, 1.2MB)
Audio-only phone services: Yes for all codes listed
Reimbursement: parity, etc.: N/A
Waiver of copays, etc.: Yes
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: N/A
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Will cover clinically appropriate medically necessary covered services |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
N/A |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
N/A |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
N/A |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
N/A |
|
E-visit Services (G2061, G2062, G2063) |
N/A |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Yes |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
Yes |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
South Carolina
BCBS SC
Type of plan: Commercial and Medicare
Coverage dates: until the end of the COVID-19 public health emergency period
References:
- Temporary expansion of reimbursement for telehealth services
- Frequently asked questions for COVID-19
Audio-only phone services: Yes, 98966-98968—Two telephonic services may occur within 7 days during the temporary modification period.
Reimbursement: parity, etc.: Paid at parity with office visits
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: The temporary telehealth expansion only applies to in-network, South Carolina providers.
Billing guidance: There is no place of service restriction on telehealth services or telephonic services.
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837 |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
N/A |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
N/A |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
96116 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
97129, 97130 |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
N/A |
|
E-visit Services (G2061, G2062, G2063) |
N/A |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
N/A |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
Tennessee
BCBS Tennessee
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: March 16, 2020 until further notice
Reference: Provider FAQ
Audio-only phone services: Unclear, but it appears that all services are covered
Reimbursement: parity, etc.: Same as in-person
Waiver of copays, etc.: If there is a COVID-19 diagnosis, we are waiving the cost-share for telehealth services performed by network providers. If telehealth is being provided for other conditions, we will continue to apply cost-share to our members.
Originating/receiving sites: N/A
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
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes |
|
Group Psychotherapy (90853, 90849) |
|
|
Family Psychotherapy (90846, 90847) |
|
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
|
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
|
|
Psychological Evaluation (96130, 96131) |
|
|
Neuropsychological Evaluation (96132, 96133) |
|
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
|
|
Neurobehavioral Status Exam (96116, 96121) |
|
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
Yes |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
|
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
|
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
|
|
E-visit Services (G2061, G2062, G2063) |
|
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
|
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
|
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
Utah
Public Employees Health Plan
Type of plan: Commercial
Coverage dates: N/A
Reference: COVID-19 alert
Audio-only phone services: N/A
Reimbursement: parity, etc.: N/A
Waiver of copays, etc.: Copays for telehealth not waived—“Starting immediately, you can do phone visits with your doctor and it will be covered. It will only cost a $10 copay for those on a traditional plan and less than $50 before deductible for those on an HSA plan. We hope that this gives you a safer and another convenient option to e-care during this difficult time.”
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: N/A
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
EMI Health plans cover any otherwise-covered service that can be appropriately performed via telemedicine that is not specifically listed in the exclusion below |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
N/A |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
N/A |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
N/A |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
N/A |
|
E-visit Services (G2061, G2062, G2063) |
N/A |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
N/A |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
SelectHealth (Intermountain)
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: No end date specified; only specification is effective date of March 1, 2020
References:
- SelectHealth behavioral health update: COVID-19 (PDF, 128KB)
- SelectHealth provider update: COVID-19 (PDF, 112KB)
Audio-only phone services: N/A
Reimbursement: parity, etc.: SelectHealth will increase reimbursement for these services for members on all plans. And “Following CMS guidance, SelectHealth will retroactively reimburse at these higher rates for dates of service beginning March 1, 2020.”
Waiver of copays, etc.: Regular copays required for prescriptions, but other than that there is no specification
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: “Bill telehealth services using the following:
- For all plans: Place of service 02
- For Commercial plans only: GT and/or 95 modifier in addition to 02 for place of service”
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837 covered for all types of plans, but 90845 covered only for Medicare and commercial |
|
Group Psychotherapy (90853, 90849) |
90853 |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
Yes |
|
Psychological Evaluation (96130, 96131) |
Does not appear to be covered |
|
Neuropsychological Evaluation (96132, 96133) |
Does not appear to be covered |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Does not appear to be covered |
|
Neurobehavioral Status Exam (96116, 96121) |
Yes |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
96112, 96113 for Medicaid and commercial only |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
96125 for Medicaid and commercial only |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
Yes, for commercial only |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
Yes, for commercial only |
|
E-visit Services (G2061, G2062, G2063) |
Yes, for Medicare only |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Yes |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
Does not appear to be covered |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
G0396, G0397 for Medicare only |
UNI-BNH (University of Utah Health)
Type of plan: Commercial
Coverage dates: N/A
References:
Audio-only phone services: Can be used for most; following CMS-approved telehealth services
Reimbursement: parity, etc.: Reimbursed at the benefit level: “payment rates are equivalent to in-person services”
Waiver of copays, etc.: No specification found
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: Telehealth video services must be billed with POS 02 or modifier -95 and “Behavioral health providers must append a Modifier CG, Policy criteria applied, to any Evaluation and Management (E/M) code reported for medication management so the claim is properly processed as a behavioral health claim.”
Distance sites: N/A
Additional information: Redirects to CMS page—“Covered CPTs include all services defined under CMS’s approved list of telehealth services, ABA therapy (CPTs 97153, 97155, 97156) and Preventive Exams (CPTs 99381-99387, 99391-99397)”
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Yes, coverage based on CMS guidelines |
|
Group Psychotherapy (90853, 90849) |
90853 |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
Yes |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
Yes, except 96170 and 96171 not covered for Medicare |
|
Psychological Evaluation (96130, 96131) |
Yes |
|
Neuropsychological Evaluation (96132, 96133) |
Yes |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
Yes |
|
Neurobehavioral Status Exam (96116, 96121) |
Yes |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
Yes, except 96112 not covered for Medicare |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
Does not appear to be covered |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
97151, 97152 |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
97153, 97154, 97155, 97156, 97157, 97158 |
|
E-visit Services (G2061, G2062, G2063) |
Not covered |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
Yes |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
Does not appear to be covered |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
G0396, G0397 |
Vermont
BCBS Vermont
Type of plan: Commerical, Medicaid
Coverage dates: Extended thru December 31, 2020
References:
- Provider news from Blue Cross and Blue Shield of Vermont
- Telemedicine payment policy (PDF, 435KB)
- Temporary/emergency policy: Telephone-only services (PDF, 247KB)
Audio-only phone services: The provider believes the patient’s needs require an office visit and
- It is not in the best interest of the patient to be seen in the office due to the coronavirus outbreak and
- The condition for which the patient is calling can be handled over the phone in a manner consistent with the current standard of care and
- Video/audio telemedicine using HIPAA-compliant equipment is not available
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: N/A
Billing guidance: N/A
Distance sites: N/A
Additional information: Only allowed when medically necessary when applicable criteria have been met
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
90791, 90832, 90834, 90837 |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
Yes |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
N/A |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
96116 |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
Does not seem to be covered |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
Does not seem to be covered |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
97151, 97152 |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
97156, 97157 |
|
E-visit Services (G2061, G2062, G2063) |
Does not seem to be covered |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
N/A |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
Yes |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
Washington
Premera Blue Cross
Type of plan: Commercial and Medicare/Medicaid
Coverage dates: extended through December 31, 2020
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. This change is in effect through June 30, 2020, per CMS guidance.
Waiver of copays, etc.: If a telehealth provider charges you a copay, deductible, or coinsurance for telehealth services through June 30, 2020, Premera will reimburse when the claim is processed.
Originating/receiving sites: N/A
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 code 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: N/A
Billing guidance: Premera is following CMS guidance on telehealth payments during the COVID-19 health crisis. Providers who normally bill POS 11 for a patient in-office visit should continue to use POS 11 for telehealth visits and the procedure code appended with either modifier 95 or GT (GT can’t be used for a Medicare claim).
Distance sites: N/A
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
For Premera-contracted providers, your current contract covers telehealth services if the care provided is appropriate within the scope of the provider’s licensure |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
N/A |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
N/A |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
N/A |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
N/A |
|
E-visit Services (G2061, G2062, G2063) |
N/A |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
N/A |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |
Wyoming
BCBS Wyoming
Type of plan: Commercial
Coverage dates: N/A
References:
Audio-only phone services: N/A
Reimbursement: parity, etc.: “Reimbursement for services is no different than those rendered in the office.”
Waiver of copays, etc.: Effective March 18, 2020, BCBSWY will waive cost share on all telemedicine services through August 31, 2020.
Originating/receiving sites: No
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: Do not use POS. Use GT Modifier.
Distance sites: N/A
Additional information: No specific codes posted but “We are encouraging network providers to increase their telemedicine efforts if the services provided are medically necessary, appropriate to be delivered via telemedicine or phone, and allowed under the providers scope of practice.”
|
Services (CPT codes) |
Coverage |
|---|---|
|
Psychotherapy (90791, 90832, 90834, 90837, 90845) |
Services provided via telemedicine must be appropriate and safe. Standard of care must be met. |
|
Group Psychotherapy (90853, 90849) |
N/A |
|
Family Psychotherapy (90846, 90847) |
N/A |
|
Crisis Intervention and Interactive (90839, 90840, 90785) |
N/A |
|
Health and Behavior Assessment/Intervention (HBAI) (96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170, 96171) |
N/A |
|
Psychological Evaluation (96130, 96131) |
N/A |
|
Neuropsychological Evaluation (96132, 96133) |
N/A |
|
Psych and Neuropsych Test Administration and Scoring (96136, 96137, 96138, 96139) |
N/A |
|
Neurobehavioral Status Exam (96116, 96121) |
N/A |
|
Developmental/Behavioral Screening and Testing (96110, 96112, 96113, 96127) |
N/A |
|
Cognitive Performance and Intervention (96125, 97129, 97130) |
N/A |
|
Adaptive Behavior Assessment (97151, 97152, 0362) |
N/A |
|
Adaptive Behavior Treatment (97153, 97154, 97155, 97156, 97157, 97158, 0373) |
N/A |
|
E-visit Services (G2061, G2062, G2063) |
N/A |
|
Telephone Assessment and Evaluation (98966, 98967, 98968) |
N/A |
|
Interdisciplinary Health Care Consultation Services Covered (99446, 99447, 99448, 99449) |
N/A |
|
Screening, Brief Intervention and Referral to Treatment (SBIRT) (G2011, G0396, G0397) |
N/A |