National and regional commercial insurers’ COVID-19 telehealth policies

References:

• Telemedicine policy is available to providers on the NaviNet and Availity portals.
• COVID-19: Telemedicine FAQs
• Our updated telemedicine policy
• Approved Behavioral Health Telemedicine Services (PDF, 173KB)

Audio-only phone services: For Commercial plans, Aetna will continue to cover limited minor acute care evaluation and care management services, as well as some behavioral health services rendered via telephone, until further notice, or as specified by state or federal regulations. Reimbursement covered, but not at same rate as office visit: 98966, 98967, 98968

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: All member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for their Commercial plans expired January, 31, 2021. Self-insured plans offer this waiver at their own discretion. Cost share waivers for any in-network covered medical and behavioral health services telemedicine visit for Aetna Student Health plans expired January 31, 2021. For Individual Aetna Medicare Advantage members, cost share waivers for specialist telehealth visits expired on January 31, 2021.

Originating/receiving sites: Physicians may provide care from any location if they abide by Aetna’s telemedicine policy. Per CMS guidance, physicians should continue to bill using their currently enrolled location. Physicians should not use their home address. This applies to both commercial and Medicare claims.

Telehealth services approved for new patients: Yes. A prior face-to-face visit is not required, but Aetna encourages patients to reach out to their current providers first.

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Out of Network Coverage based on member plan/benefits; Teledoc optional

Billing guidance: For commercial members nonfacility telemedicine claims must use POS 02 with the GT or 95 modifier. For Medicare members, POS 02 or POS 11, or the POS equal to what it would have been had the service been furnished in-person, along with the 95 modifier indicating that the service rendered was actually performed via telehealth, may be utilized and will reimburse at the same rate.

Distance sites: Yes. Must bill using enrolled location

Additional information: Coverage plan-based; Medicaid coverage determined by state Medicaid agency. Providers can temporarily use nonpublic-facing synchronous video chat platforms, such as Skype^® and FaceTime^®, to complete telemedicine visits as long as these platforms are allowed in their states and they are able to meet the standard of care via a telehealth encounter. Health care providers should not, however, use public-facing video applications, such as Facebook Live^®, Twitch^®, or TikTok^®.

State mandates:

• Massachusetts—televideo coverage for ABA codes 97154 and 97158
• New York—audio coverage for IOP codes H0015, H2012 and S9480

References:

• Commercial: Provider news
• Medicaid: COVID-19 news and updates
• Medicare: Provider news archives
• COVID-19 Update: Guidance for telehealth/telephonic care for behavioral health services (note: this website is specific to Indiana but our review indicates that these bulletins are identical between Anthem states. We recommend that you check the bulletin for your state. It appears the information for California has not been updated since March 12, 2021)

Audio-only phone services: March 19, 2020 until further notice, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers. Out-of-network coverage will be provided where required by law. March 19, 2020, through July 15, 2022, Anthem will cover and waive cost shares for telephonic-only visits with in-network providers for Medicare Advantage plans.

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: For COVID-19 treatment related telehealth visits, Anthem’s affiliated health plans will waive member cost shares from in-network providers throughout the duration of the public emergency.

From March 17, 2020, to September 30, 2020, Anthem’s affiliated health plans waived member cost share for telehealth (video + audio) in-network provider visits for services not related to treatment of COVID-19, including visits for behavioral health, for fully-insured employer plans and individual plans. From March 17, 2020, through December 31, 2020, Anthem waived member cost shares for telehealth visits for services not related to the treatment of COVID-19 from in-network providers, including visits for mental health and substance use disorders, for Medicare Advantage and Medicaid plans, where permissible. For out-of-network providers, Anthem waived cost shares from March 17, 2020, through June 14, 2020. Cost sharing will be waived for members using Anthem’s telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-funded customers encouraged to participate, and these plans will have an opportunity to opt in.

Effective March 19, 2020 until further notice, Anthem will cover telephone-only medical and behavioral health services from in-network providers and out-of-network providers when required by state law. Anthem will waive associated cost shares from March 19, 2020, through May 31, 2021, for in-network providers only except where a broader waiver is required by law. Self-funded customers encouraged to participate, and these plans will have an opportunity to opt in.

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: If members do not have appropriate access to network doctors, will authorize coverage for out-of-network doctors as medically necessary. LiveHealth Online optional.

Billing guidance: POS 02 or 10 with modifier GT or 95. For Medicare Advantage only use 02. For existing patients in a bordering state, use primary address where you would have normally seen patient face to face. For telephonic visit submit with the correct time-based CPT code (99441, 99442, 99443, 98966, 98967, 98968) and the place of service code that depicts where the provider’s telephonic-only services occurred.

Distance sites: If the provider can effectively deliver services via telehealth from another location (e.g., the provider’s home), while also maintaining the patient’s privacy, the services are payable.

Additional information: Anthem states that all mental health outpatient and Psychological Testing services must be “HIPAA compliant.” Unless otherwise stated, the policies listed are for commercial.

References:

• COVID-19 (coronavirus) resource center
• COVID-19 Telehealth Updates

Audio-only phone services: 98966, 98967, 98968

Reimbursement: parity, etc.: Yes. FEP will cover telehealth services from preferred providers (plan-based)

Waiver of copays, etc.: Prior authorizations for diagnostic tests and covered services. Cost share waived for telehealth services received through Teledoc. Waiving copays for telehealth services 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: No out-of-network; Teladoc optional.

Billing guidance: Place of Service (POS) 02 or 10; acceptable modifiers 95, GT, and GQ

Distance sites: N/A

References:

• Provider FAQs: COVID-19 (PDF, 811KB)
• Applied Behavior Analysis COVID-19 FAQs (PDF, 757KB)
• MassHealth coverage and reimbursement policy for services related to coronavirus disease 2019 (COVID-19) (PDF, 184KB)
• Temporary provider telehealth guidance (PDF, 203KB)
• Business Support FAQs for Providers (PDF, 810KB)

Audio-only phone services: Yes—98966, 98967, 98968

Reimbursement: parity, etc.: Yes, unless an existing fee schedule specifies otherwise

Waiver of copays, etc.: During this time of public health emergency, in order to begin or ensure access to care for members, most plans will waive cost sharing for routine outpatient telehealth and for all ABA services. Members covered by self-funded employer sponsored plans and some commercial and government health plans will continue to follow the plans’ guidelines and policies which may not waive cost shares.

Originating/receiving sites: CMS temporarily removed the “eligible originating site” requirement and Medicare can pay for office, hospital, and other visits furnished via telehealth across the country including in patient’s places of residence starting March 6, 2020.

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: Beacon is not imposing specific requirements for technologies used to deliver services via phone or telehealth. At this time, Beacon is focused on increasing telehealth access through its vast provider network through training, support, and ease of claims submission. In addition, Beacon is looking to further leverage MDLive as its enterprise telehealth partner and increase penetration of their services. Finally, Beacon is also exploring digital therapeutics to amplify the impact of its network and increase access to self-guided evidence-based tools during this time of need.

Billing guidance: Providers should continue to bill as they always have, using the same codes and modifiers, unless the federal government or states have issued individual billing guidance. GT or 95 modifier and/or Place of Service (POS) 02

Distance sites: MassHealth—While all applicable licensure and programmatic requirements apply to the delivery of the service, there are no additional geographic or facility restrictions on distant sites for services delivered via telehealth.

Additional information: Beacon appears to be applying CMS Guidance on Medicare coverage as Temporary Provider Telehealth Guidance

References:

• Cigna’s response to COVID-19
• COVID-19: Interim Guidance
• Virtual Care Online Resource
• Virtual Care Reimbursement Policy

Audio-only phone services: Cigna will not make any requirements regarding the type of technology used (i.e., phone, video, FaceTime, Skype, etc. are all appropriate to use at this time). You may provide telephonic sessions to patients who do not have access to technology to participate in telehealth sessions, as appropriate.

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: For covered virtual care services by a provider or virtual vendor (e.g., MDLive), cost-share will apply as follows:

• For COVID-19 related screening (i.e., quick phone or video consult): No cost-share for customers through July 14, 2022
• For non-COVID-19 related services (e.g., oncology visit, routine follow-up care): Standard customer cost-share

Originating/receiving sites: No reimbursement will be made for the originating site of service fee or facility fee.

Telehealth services approved for new patients: Yes. Cigna will not make any requirements as it relates to these services being for a new or existing patient.

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: The Virtual Care Reimbursement Policy also applies to nonparticipating providers. Nonparticipating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. Use of virtual care vendor like MDLive optional.

Billing guidance: Modifier 95, GT, or GQ (or 93 or FQ accepted effective July 1, 2022) must be appended to the virtual care code(s). Billing POS 02 for virtual services may result in reduced payment or denied claims. Therefore, providers should bill a typical place of service (e.g., POS 11) to ensure they receive the same reimbursement as they typically get for a face-to-face visit. Effective July 1, 2022, all virtual care services must be submitted with POS 2 (do not bill POS 10 until further notice).

Distance sites: N/A

Additional information: Cigna will not make any requirements regarding the type of technology used for virtual care (i.e., phone, video, FaceTime, Skype, etc. are all appropriate to use at this time).

References:

• Humana update for telehealth visits
• Telehealth FAQs
• COVID-19 Telehealth and Other Virtual Services
• Humana Telehealth Reference Guide for Providers (PDF, 238KB)

Audio-only phone services: Temporarily accepting telephone (audio-only) visits.

Reimbursement: parity, etc.: Yes, for in-network

Waiver of copays, etc.: As of January 1, 2021, Medicare Advantage benefits include no member cost share for in-network telehealth visits for primary care, urgent care, and behavioral health. For specialty telehealth visits, please verify member plan benefits as any applicable member cost share would apply.

Originating/receiving sites: Yes. Humana will adopt all waivers CMS publishes for services provided via telehealth to its Medicare Advantage members, including those pertaining to originating site requirements.

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: Yes—plan-based. MDLive and Doctors on Demand Optional. Additional virtual care solutions include doxy.me and VSee.

Billing guidance: Place of Service (POS) code that would have been reported had the service been furnished in person. Report a telehealth or other virtual service with modifier 95 or FQ, as applicable, to identify that the service was furnished via telecommunications-based technology.

Distance sites: Yes. If the distant site practitioner requirements are satisfied, the home health service must also be one that is approved for telehealth.

Additional information:

• Humana Florida Medicaid plans allow telehealth and other virtual services according to the applicable Agency for Health Care Administration (AHCA) guidance. Refer to the AHCA for the latest guidance on billing and reimbursement for telehealth and other virtual services during the PHE. See the relevant AHCA guidance in the References section of this policy.
• Humana Illinois Medicaid plans allow telehealth and other virtual services according to the applicable Illinois Department of Healthcare and Family Services (IHFS) guidance. Refer to the IHFS for the latest guidance on billing and reimbursement for telehealth and other virtual services during the PHE. See the relevant IHFS guidance in the References section of this policy.
• Humana Kentucky Medicaid plans allow telehealth and other virtual services according to the applicable Kentucky Department for Medicaid Services (DMS) guidance. Refer to the DMS for the latest guidance on billing and reimbursement for telehealth and other virtual services during the PHE. See the relevant DMS guidance in the References section of this policy.

References:

• Telehealth: Get mental health treatment wherever you are (PDF, 129KB)
• COVID-19 crisis: Behavioral health network provider Q&A (PDF, 221KB)
• Billing instructions for Magellan telehealth providers (PDF, 142KB)
• Telehealth Payable Services—2021 (PDF, 197KB)
• ABA Modifiers and Codes during COVID-19 (PDF, 132KB)

Audio-only phone services: Yes if telehealth platform not accessible, no for testing

Reimbursement: parity, etc.: Yes—telephone sessions billable

Waiver of copays, etc.: Attestation. Some states or plans may be waiving member cost-sharing during the crisis. To check member eligibility and benefits, sign into Magellan Provider.com and select the Check Member Eligibility application from the menu, or call us at the number on the back of the member’s benefits card. Also, be sure to stay up to date with any mandates your particular state has implemented.

Originating/receiving sites: Not specified

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: Yes

Billing guidance: Place of Service 02 and modifier GT or 95. If you provide outpatient sessions using the telephone or a non-HIPAA compliant telehealth platform, bill with the GQ modifier.

Distance sites: Not specified

Additional information: Coverage plan-based. You may use telephone or a nonpublic method such as Skype or FaceTime for sessions. Note: Public-facing sites such as Facebook Live and Twitch should never be used for telehealth. Preauthorization as normally required.

References:

• Become an Optum virtual visit telemental health provider
• Updates to telehealth policies for assessment services
• COVID-19 outpatient telehealth policy updates
• Optum: Waived cost-sharing for members for in-network non-COVID telehealth (PDF, 32KB)
• COVID-19 reimbursement guidelines
• FAQ for Optum providers: COVID-19 and temporary virtual visit policies (PDF, 79KB)

Audio-only phone services: Providers who do not have access to HIPAA-approved technology or certain video chat platforms can provide phone services. But any provider can use phone-only for assessment services.

Reimbursement: parity, etc.: No indication that telehealth reimbursement is at a lower rate

Waiver of copays, etc.: Temporary cost share policy updated May 24, 2021

• Medicare Advantage: Extended cost-share waiver ended September 30, 2020.
• Medicaid: State regulations apply. If no state guidance was provided, waiver ended June 18, 2020.
• Commercial: For in-network providers, extended cost share waiver for telehealth services ended September 30, 2020. For out-of-network providers, the cost share waiver for telehealth services does not apply. Implementation of these temporary changes for self-funded customers may vary. Depending on a member’s health plan, providers may need to adjust their administrative processes and systems when collecting member cost share (copays, coinsurance, and deductibles) to determine if a member has a self-funded plan.

Note: The following five states continued to waive the cost-share waiver beyond September 30, 2020:

• Illinois—ended July 23, 2021
• North Dakota—ended May 1, 2021
• New Jersey—currently extended, no expiration date announced
• New York—ended June 5, 2021
• Rhode Island—ended July 7, 2021

Originating/receiving sites: For all UnitedHealthcare Individual and fully insured Group Market health plans, any originating site or audio-video requirements under UnitedHealthcare reimbursement policies are temporarily waived. UnitedHealthcare is waiving the CMS originating site restriction through the national public health emergency period.

Telehealth services approved for new patients: There appear to be no limitations to existing patients.

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Appears to apply broadly but Optum reimburses out-of-network providers at the same out-of-network rate as it applies per the benefit plan. Only providers in the Optum network can register to use the Optum virtual visits platform. Optum has its own TH platform available to in-network providers, but does not have a separate TH carve out network.

Billing guidance:

• Commercial: Use standard CPT codes and a GT, GQ, and 95 modifier and a Place of Service of 02 for both video-enabled virtual visits and telephonic sessions to indicate the visit was conducted remotely. Noncontracted providers should use the Place of Service code they would have used had the service been furnished in person (for example, Place of Service code 11). In accordance with CMS guidance, providers should not bill using CPT code(s) for telephonic therapy.
• Medicaid: For UnitedHealthcare Community Plan use standard procedure codes such as CPT/HCPCS codes and Place of Service 02, or state Medicaid telehealth billing requirements if different than using 02 for both video-enabled virtual visits and telephonic sessions.
• Medicare Advantage: Use standard CPT codes and Place of Service 02 and/or GQ or 95 modifier for both video-enabled virtual visits and telephonic sessions.
• Note: Billing modifiers may be different for neuropsychologists, health psychologists, and others credentialed/billing through the parent company, UnitedHealthcare.

Distance sites: N/A

Additional information: For assessment services, Optum expects providers to adhere to the APA guidelines for the practice of telepsychology, particularly Guideline 7: Testing and Assessment.

References:

• COVID-19 coverage support for providers
• Telehealth/telemedicine services temporary policy in response to COVID-19 public emergency (PDF, 985KB)

Audio-only phone services: 98966-98968 and 99446-99449

Reimbursement: parity, etc.: During the COVID-19 National Emergency, claims billed with a POS 02 or POS 10 will reimburse using the Non-Facility Fee Schedule. During this COVID-19 National Emergency, claims billed with modifier 95 will reimburse using the same fee schedule as if the visit occurred face-to-face.

Waiver of copays, etc.: Cost share waivers ended December 31, 2020

Originating/receiving sites: “An originating site does not need to be billed for a telemedicine service.” Member can be located at home for telehealth and telephone visits.

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: Place of Service Code (POS) 02 or 10 should be billed for telemedicine. POS code that would be have been used if the visit had occurred face-to-face acceptable; must use modifier 95. With the exception of modifier 95 with a POS other than 02 or 10, none of these modifiers are required for payment: GT, GQ, G0, 95.

Distance sites: Provider can be located at home for telehealth and telephone visits.

References:

• Supporting our trusted provider partners
• FAQs for members

Audio-only phone services: Require video and audio

Reimbursement: parity, etc.: N/A

Waiver of copays, etc.: Standard cost-share apply in all states except New Jersey—until further notice, New Jersey—through end of both state of emergency and PHE, Arizona—during PHE, and Colorado—until further notice.

Originating/receiving sites: N/A

Telehealth services approved for new patients: Yes

Telehealth policy applies to out of network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: In-network only. $0 telemedicine to most members through Oscar’s Doctor on Call.

Billing guidance: POS Codes and Modifiers recognized by AMA/CMS for Telemedicine Related Services: POS 02—place of service “telehealth” Providers should submit procedure codes with a modifier: Modifier 95—synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. Modifier GT—services delivered via interactive audio and video telecommunications system.

Distance sites: N/A

Additional information: Oscar will consider for reimbursement telehealth services which are recognized by CMS.

Reference: HCSC COVID-19 Info

Audio-only phone services: Following CMS guidelines for Medicare members. See the CMS website for designated audio-only codes.

Reimbursement: parity, etc.: same rate as in-person office visits

Waiver of copays, etc.: The cost-sharing waiver for fully insured in-network telehealth continues in accordance with Governor Pritzker’s Telehealth Executive Order and Illinois Department of Insurance guidance.

Originating/receiving sites: A member can receive telehealth in their home, but there would be no originating site in this instance.

Telehealth services approved for new patients: Providers can now engage in telehealth services with new Medicare patients.

Telehealth policy applies to out-of-network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Usage of out-of-network providers may increase a member’s out-of-pocket responsibilities. Use of telehealth vendor MDLive optional.

Billing guidance: Modifiers 95 and GT

Distance sites: Providers at distant sites can deliver services in line with their normal scope of billable services from their respective fee schedules.

References:

• HCSC COVID-19 Info
• Telemedicine 2021—Provider and Network FAQs (PDF, 200KB)

Audio-only phone services: Yes. Following CMS guidelines for Medicare members. See the CMS website for designated audio-only codes.

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: As of January 1, 2021, copays, deductibles, and coinsurance apply to telemedicine visits. The cost share varies according to the member’s benefit plans. Check eligibility and benefits for each member for details.

Telehealth services approved for new patients: Yes

Telehealth policy applies to out-of-network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: For fully insured members, providers are not required to use a vendor for telemedicine services. For self-funded plans, members may be required to use specific vendors, such as MDLive as outlined in the member’s benefit plan.

Billing guidance: Submit claims for medically necessary services delivered via telemedicine with the appropriate modifiers (95, GT, GQ, G0) and Place of Service (POS) 02

Distance sites: N/A

References:

• HCSC COVID-19 Info
• COVID-19: FAQs for Medicare Providers (PDF, 242KB)

Audio-only phone services: Following CMS guidelines.

Reimbursement: parity, etc.: Reimbursed at parity with in-person office visits

Waiver of copays, etc.: As of January 1, 2021, copays, deductibles, and coinsurance applicable to telemedicine visits. Waiving cost share for Medicare Advantage members telehealth visits for the duration of the COVID-19 public health emergency.

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: Reimburse out-of-network providers according to the CMS reimbursement rates. Usage of telehealth vendor not required.

Billing guidance: Modifiers (95, GT, GQ, G0) and Place of Service (POS) 02 or POS that would have been billed had the services been delivered face to face.

Distance sites: N/A

Additional information: After COVID-19 accommodations expire, covering telemedicine codes consistent with the code lists from:

• Centers for Medicare and Medicaid Services
• American Medical Association

References:

• Telemedicine FAQs 2021—Blue Cross and Blue Shield of Oklahoma (PDF, 197KB)
• HCSC COVID-19 Info

Audio-only phone services: Yes, for Medicare members, following the CMS permanent code lists, which cover certain audio-only codes.

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

Waiver of copays, etc.: Telemedicine cost-sharing waiver ended December 31, 2020. For the duration of the PHE, waiving cost share for Medicare Advantage members only.

Originating/receiving sites: N/A

Telehealth services approved for new patients: As of January 1, 2021, copays, deductibles, and coinsurance apply to telemedicine visits. The cost share varies according to the member’s benefit plans. Waiving cost share for our Medicare Advantage members for duration of PHE. Some self-funded members may have cost share for telemedicine visits waived.

Telehealth policy applies to out-of-network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: For state-regulated fully insured members, providers are not required to use a vendor for telemedicine services. For self-funded plans, members may be required to use specific vendors, such as MDLive as outlined in the member’s benefit plan.

Billing guidance: Use appropriate modifiers (95, GT, GQ, G0) and Place of Service (POS) 02.

Distance sites: N/A

Additional information: Blue Cross and Blue Shield of Oklahoma will evaluate codes that are not Medicare-covered benefits to determine if they can be delivered effectively through telemedicine.

References:

• HCSC COVID-19 Info
• Blue Cross and Blue Shield of Texas telemedicine and telehealth services

Audio-only phone services: Yes. Following CMS designated audio-only codes for Medicare members.

Reimbursement: parity, etc.: Same rate as in-person office visit

Waiver of copays, etc.: As of January 1, 2021, copays, deductibles, and coinsurance may apply to telehealth visits. The cost share varies according to the member’s benefit plans. Self-funded employer group customers make decisions for their employee benefit plans and may choose to waive telemedicine cost share. Waiving cost share for Medicare Advantage members for duration of PHE.

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: Applies to in-network only. For state-regulated fully insured members, providers are not required to use a vendor for telehealth services. For self-funded members, providers may be required to use specific vendors as outlined in the member’s benefit plan.

Billing guidance: Use appropriate modifiers (95, GT, GQ, G0) and Place of Service (POS) 02

Distance sites: N/A

Additional information: No longer limiting coverage of telehealth services to CMS and AMA permanent lists, however, coverage plan-based.

References:

• Regence BlueCross BlueShield telehealth visits
• Regence BlueCross BlueShield virtual care reimbursement policy

Audio-only phone services: For individual and group members (including ASO) Telehealth services may be conducted via audio or video. For audio-only, must have an established relationship between member and provider. Telehealth visits with Medicare Advantage patients must be conducted using real-time via audio and video.

Reimbursement: parity, etc.: As of July 1, 2021 reimburse providers for expanded telehealth at the facility relative value unit (RVU) reimbursement rate.
For Washington-based providers: Will reimburse Washington-based providers for any expanded and standard telehealth services based on Senate Bill 5385, Telemedicine Payment Parity.

Waiver of copays, etc.: ASO groups have the option to waive the deductible for expanded telehealth services. To verify if the deductible is waived for expanded telehealth services, contact our provider contact center.

Originating/receiving sites: Allow for outpatient facility billing for HCPCS Q3014 Telehealth originating site facility fee when the originating site for telemedicine is the Medicare Advantage member’s home and the member is registered as an outpatient of the hospital for purposes of receiving telehealth services billed by the provider. Note: For Individual and group members, HCPCS Q3014 is only reimbursable when the member is in the health care facility during the virtual visit.

Telehealth services approved for new patients: If a Provider offering Virtual Care services does not have an established provider-member relationship with a Member seeking such services, steps should be taken to establish a provider-member relationship through a combination of audio and video communication and not audio-only communication.

Telehealth policy applies to out-of-network? Services limited to telehealth carve out company, e.g., Teladoc, MDLive: Telehealth services can be provided to Medicare Advantage PPO members by out-of-network providers. MDLive and Doctor On Demand optional and accessible based on member plan.

Billing guidance: Individual and group—As of July 1, 2021 claims for eligible telehealth services must be billed with POS 02 or POS 10 and modifier GT. Modifier 95 will no longer be accepted as an indicator for telehealth services. Audio-only services must also have the FQ modifier appended in addition to the GT modifier.

Distance sites: Providers location must be listed on the provider’s enrollment file. Provider must be licensed and enrolled in the state that the services are rendered in.

Additional information: Coverage plan-based

References:

• CareFirst Health care providers telemedicine guidelines
• CareFirst procedure code/modifier/place of service instructions for telemedicine claims during COVID-19 public health emergency (PDF, 89KB)

Audio-only phone services: Audio-only telehealth is covered when a patient is unable to participate in an audiovisual visit in lieu of an in-person office visit. Where required, CareFirst will cover audio-only calls that result in the delivery of a billable, covered health care service.

Maryland Preserve Telehealth Access Act: Effective July 1, 2021 expanded the definition of telehealth to include audio-only calls that result in the delivery of a billable, covered healthcare service. This mandate expires June 30, 2023 and is applicable to patients enrolled in fully insured Maryland benefit plans.

Reimbursement: parity, etc.: Not specified

Waiver of copays, etc.: Waiving cost sharing for in-network or out-of-network visits to a provider’s office related to diagnosis and treatment of COVID-19.

Originating/receiving sites: Home or clinic

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: Yes—out of network. CareFirst Video Visit optional.

Billing guidance: Place of service “02” and appropriate modifier (95 or GT)

Distance sites: N/A

Additional information: Coverage plan-based

References:

• Highmark provider resources—Telemedicine and virtual visits
• Highmark (temporary) telemedicine code list (PDF, 552KB)
• Highmark reimbursement policy bulletin (PDF, 3.01MB)
• Highmark provider manual—Chapter 2.5: Telemedicine services (PDF, 484KB)

Audio-only phone services: Yes

Reimbursement: parity, etc.: Yes, this allowance is currently set to expire after December 31, 2023.

Waiver of copays, etc.: The waiver of Highmark member cost-sharing for in-network telehealth visits is effective for dates of service from March 13 through June 30, 2021. As of July 1, 2021, regular member cost-sharing for telehealth visits applies.

Originating/receiving sites: Medical site or an approved nonmedical site

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: Virtual visits covered for in-network providers. Members may be responsible for higher cost-sharing amounts for services provided by an out-of-network specialist. Usage of approved telemedicine vendors—(Amwell)™, Doctor On Demand™, Teladoc™, and Bright Heart Health not required. Highmark Medicare Advantage plans continue to follow CMS’s guidelines for telemedicine visit coverage and reimbursement. Only the codes identified by CMS as appropriate for telemedicine services will be reimbursed by Highmark for Medicare Advantage members.

Billing guidance: Place of Service 02 or 10 and modifier GT or 95. Modifier FQ or 93 must be appended for audio-only.

Distance sites: The distant site is the location where the provider (legally allowed to practice in the state) is rendering the service by means of telemedicine or telehealth. The plan will not reimburse claims submitted for an access fee by the distant site.

References:

• MVP provider COVID-19 updates
• MVP 2020 payment policies (PDF, 3.1MB)

Audio-only phone services: Yes

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: No cost-share to the member during the declared state of emergency.

Originating/receiving sites: Medical or nonmedical, including the member’s place of residence located within the state of New York or other temporary location located within or outside the state of New York. Originating site facility fee is reimbursed a flat fee of $25.

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: If the member has out-of-network benefits, they can use those benefits to see a nonparticipating care provider. However, they may pay more when using them. Members who do not have out-of-network benefits may have high costs or pay all the costs for the nonparticipating care provider. No requirement for use of telehealth vendor specified.

Billing guidance: Use appropriate place of services (POS) code that would have been reported had the services been furnished in person and modifiers “95” or “GT”

Distance sites: Reimbursement for the distant site provider in New York for Medicare, Child Health Plus, and Commercial products will be based on the CMS allowed telehealth codes referenced in this policy and reimbursed at 100% of the applicable contracted fee schedule. Reimbursement for the distant site provider for Medicaid and Essential Plan will follow New York state Medicaid requirements and pay at 100% of the applicable contracted government programs fee schedule. Reimbursement for the distant site provider for Vermont for all products will follow Vermont state requirements and pay at 100% of the physicians contracted fee schedule.

References:

• Wellmark Support during COVID-19
• Wellmark coronavirus (COVID-19) frequently asked questions (FAQ)

Audio-only phone services: Yes, when audio/visual not accessible; must be documented in medical record. Effective September 1, 2021, Wellmark will no longer allow telephonic (audio-only) visits for telehealth services for any provider, and all providers will be required to comply with Wellmark’s Provider Guide for billing services performed by telehealth.

Reimbursement: parity, etc.: Yes

Waiver of copays, etc.: As of August 31, 2020, a fully insured member will need to pay their standard cost-share for that benefit, which is no more for telehealth than an in-person visit.

Originating/receiving sites: May be patient’s home

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, Doctor On Demand optional. Doctor On Demand has contracted with Medicare and will now be covered by Medicare supplement policy according to member benefits.

Billing guidance: Do not use a modifier to bill virtual visits to Wellmark. Virtual visits should be billed using Place of Service 02 (telehealth). For facility billing, use GT modifier when medically appropriate.

Distance sites: N/A