PLAN-BY-PLAN INSURANCE COVERAGE OF TELEHEALTH IN RESPONSE TO COVID-19

by Barbara Griswold, LMFT
www.theinsurancemaze.com  barbgris@aol.com

Parts updated at various times — CHECK BACK FREQUENTLY FOR UPDATES

IMPORTANT UPDATE:  Many insurance plans note that they need you to use a secure HIPAA-compliant platform.  HOWEVER, as of 3/17/20, the US Dept of Health and Human Services waived enforcement of HIPAA regulations during this health emergency, see complete article here

Disclaimer: While I do my best to verify this information, the best way to verify if a client has telehealth coverage is by contacting the plan, via phone or email.  Even within a specific plan that covers telehealth, some clients may not have this benefit (especially if the plan is Self-Funded/Self-Insured/ERISA), and coverage may vary by state and employer account.  If you have corrections or additions, please send verifiable information to me at barbgris@aol.com. I cannot be held accountable for negative consequences caused by inaccurate information.

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• READ MY LATEST ARTICLE ON BILLING FOR TELEHEALTH HERE

AETNA

• For up-to-date information, visit: https://tinyurl.com/aetnatelehealth
• The claim should be billed with Place of Service Code 02 and the Modifier 95 or GT
• NOTE from BG: While members do not have to pay their copays when seeing a network provider via Telehealth, they do when seeing an out of network provider.
• Update as of 9/16/20:  “Aetna’s liberalized coverage of Commercial telemedicine services, as described in its telemedicine policy, will now extend through December 31, 2020 (or as specified by state or federal regulation).^. Aetna extended all member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services through December 31, 2020 (or as specified by state or federal regulation).  Aetna self-insured plan sponsors offer this waiver at their discretion. Cost share waivers for any in-network covered medical or behavioral health services telemedicine visit for Aetna Student Health plans are extended until September 30, 2020.  Medicare Advantage will continue to waive cost shares for in-network primary care and specialist telehealth visits, including outpatient behavioral and mental health counseling services through December 31, 2020.  Please refer to the Telemedicine Policy for services covered.”

ALWAYS HEALTH PARTNERS

• “Always Health Partners is removing all cost-sharing for telemedicine services, including virtual visits with primary care providers and specialists, and through Partners HealthCare On Demand, to enable members to seek COVID-19-related care without the need to go to medical offices.”
• To read policies, click here: Always Health Partners

AMERIHEALTH NEW JERSEY

“To help reduce potential exposure, AmeriHealth New Jersey encourages members to utilize telemedicine services if they are available as part of a member’s plan. To support use of these services, AmeriHealth New Jersey will waive cost-sharing, where applicable,  for phone and video telemedicine visits for 90 days (through June 4). To access telemedicine options, members should login to our member website at amerihealthnj.com.”  For details click here

ANTHEM BLUE CROSS OF CALIFORNIA

ANTHEM BLUE CROSS OF CALIFORNIA EAP

” We can amend your contract to include telephonic counseling at any time. With EAP, we do not make a distinction with regard to telephonic/telehealth, so when you amend your contract, we would allow phone calls as well as video sessions with a HIPAA compliant platform. We do not make recommendations on platforms but it is your responsibility to comply with federal (HIPAA) and any state regulatory mandates around information security with those platforms. Telehealth sessions are paid at the same contracted rate as face to face. “

Source: March 12, 2020 email from Philip Prewitt, MA LPC, Manager, Network Relations, Anthem Employee Assistance Program Provider Networks, 700 Broadway, Denver, Colorado 80273, Office: 303-869-3191, Mail code: CO0105-0542. philip.prewitt@anthem.com,  EAPProviderNetworks@anthem.com,

ANTHEM BLUE CROSS MEDI-CAL

“The plan will cover psychotherapy sessions provided via telehealth to new or existing clients (ex. CPT code 90837,90834, 90847) Video sessions are covered, we are still waiting on guidance from leadership as to whether phone sessions will be covered.  No additional authorization is required to render telehealth services. Only ABA and Psych Testing require prior auth for our Medi-Cal network. There are no other requirements for the provider to be covered (ex. client location, therapist on approved telehealth list.In terms of billing and mofiers, please refer to the DHCS’s telehealth policy https://www.dhcs.ca.gov/provgovpart/Pages/Telehealth.aspx. Modifiers and Place of Service coding are addressed.
Updates to the telehealth policy include the following:
• Allow Medi-Cal providers flexibility to determine if a particular service or benefit is clinically appropriate for telehealth via audio-visual two-way real time communication and store and forward.
• Place no limitations on origination or distant sites.
• Implement Place of Service Code 02 for all services delivered via telehealth and modifier 95 for services delivered via audio-visual two-way communication.
Telehealth will be covered at the same rate as in person sessions
There is no need to alter your provider contract to include telehealth.  Providers can use any telehealth platform that is HIPAA Compliant”
Note from author: It is unclear if provider must be in-network with the plan to provide telehealth.”

Source: 3/16/20 email to author from Rita Salazar, Network Relations Consultant, Anthem CA Medicaid Provider Solutions – Behavioral Health. F: (855) 514-9240. BHMedi-CalNetworkRelations@anthem.com

ANTHEM OF CONNECTICUT

ASURIS NORTHWEST HEALTH

Communication from Asuris, provided by provider 6/1/21:

“The following updates apply to medical and behavioral health telehealth services.

Effective for dates of service on or after July 1, 2021, for Individual, group (including administrative services only [ASO]), and Medicare Advantage members:

– Claims for eligible telehealth services must be billed with place of service 02 (POS 02) and modifier GT.

– Modifier 95 will no longer be accepted as an indicator for telehealth services.

For telehealth services submitted following the guidelines above and for services that are included in our Virtual Care (Administrative #132) reimbursement policy:

– Provider reimbursement will continue to be based on Senate Bill 5385 where applicable

– Note: Services included in our Virtual Care (Administrative #132) reimbursement policy will apply to the member’s telehealth benefit, if applicable.

Expanded code list

We will continue to cover telehealth services included on the Centers for Medicare & Medicaid Services’ (CMS’) List of Telehealth Services, available at cms.gov/Medicare/Medicare‐General‐Information/ Telehealth/Telehealth‐Codes.

BEACON HEALTH OPTIONS (For MEDI-CAL, see next listing; for Kaiser Northern California, see #2 below)

1. Email to providers from Beacon 3/20/20: “We appreciate your partnership over the past several days as we looked for ways to increase members’ access to telehealth and to help you continue to provide quality behavioral health services to your patients during this unprecedented time. To mitigate the spread of COVID-19, Beacon is committed to enabling members to remain in their homes to reduce exposure and transmission, and to preserve health system capacity for the duration of this public health emergency consistent with governmental mandates. Where telephonic or Telehealth Services are covered by a member’s plan, Beacon will permit providers to deliver clinically appropriate, medically necessary covered services to members via telephone or telehealth (secure live video conferencing). Moreover, Beacon strongly encourages providers to utilize this increased telehealth flexibility to maximize the number of services provided by telephone or telehealth.  The following changes are effective immediately (until further notice) for providers serving Beacon members:

2. Beacon for Kaiser Northern California:  4/27/20 conversation with Beacon rep for dedicated Beacon Provider line (855-471-7005), rep states that phone and video sessions have been permitted for all Kaiser/Beacon clients as long as there is a Kaiser authorization in place.  Use Place of Service code 02, and while 95 Modifier is accepted it is not required.  At this point copayments are being waived.  

3. “Beacon Health Options is strongly committed to our members, clients and providers to ensure that mental health needs are being met during this stressful time.  We recognize that many of our members and providers are being encouraged or mandated to stay at home in order to prevent community spread of coronavirus.  When clinically appropriate, telehealth can be an effective way for members to begin or continue their care through a mental health provider safely from their homes via phone, tablet or computer-enabled web cam.  Providers are encouraged to use appropriate technologies to communicate with individuals and to ensure that adequate confidentiality and security protections are in place.  Clinical documentation for telehealth services is similar to that created for face-to-face documentation for services. Where permitted by a health plan, reimbursement for covered services delivered through telephone and telehealth will be allowed so long as such services are clinically appropriate.  We are working with our clients to evaluate the opportunity to waive co-pays for mental telehealth visits, where permissible, and in accordance with state and federal regulations.”

Source:  3/20/20 email to author from Chris Curran, VP Brand Strategy, Beacon Health,  Chris.Curran@beaconhealthoptions.com

4. “At the moment due to the crisis, please feel free to conduct telehealth services, we will f/u later with required documentation.”

source: email 3/16/20(?) from Eddie Vivero to beacon Provider, Mr. Vivero is Contract Development Manager, Beacon Health Options, 5665 Plaza Drive, Suite 400, Cypress, CA 90630 Office: 562.246.3793, edward.vivero@beaconhealthoptions.com.     www.beaconhealthoptions.com

5. ” Telehealth is being allowed for all providers due to COVID-19.  Beacon is currently working to send out notice/announcement to all providers with further information.”

 source: email 3/17/20 to a provider via Secure messaging from Beacon Provider Relations Department, Beacon Health Options, P.O. Box 1866, Hicksville, NY 11802-1866, Phone: 800-397-1630, Direct Provider Relations Fax: 800.646.9371. www.beaconhealthoptions.com

BEACON MEDI-CAL

• • No contract adjustments or signed attestation is required to provide services to Medi-Cal members.

• • The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) Notification of Enforcement Discretion have stated that they will not be enforcing HIPAA compliance for telehealth remote communications during the COVID-19 nationwide public health emergency.
  • Beacon is not imposing specific requirements for technologies used to deliver services via telehealth and will allow reimbursement for covered services delivered through telephone or telehealth so long as such services are medically necessary and clinically appropriate. Providers are reminded, however, that state confidentiality may still apply.
  • Providers are encouraged to use appropriate HIPAA compliant telehealth platforms to communicate with individuals. When leveraging widely available communication apps, such as FaceTime or Skype, to the extent feasible, ensure the same rights to confidentiality and security as provided in face-to-face services. Providers must inform members of any relevant privacy considerations.
  • There are no site restrictions on where services are performed for Medi-Cal members.
  • Clinical documentation for telehealth services is the same as face to face documentation for services.
  • Rates of payment for services delivered via Telehealth will be the same as rates of payment for services delivered via traditional in-person methods as it applies to your contract. Providers should continue normal billing practices until further notice. Providers will be able to bill Beacon for these services delivered via telephone or telehealth beginning March 16, 2020, for a period of time to be determined.
  • The situation with COVID-19 is very dynamic, we will continue to monitor developments and review the proposed end date each week as we have new information.”
  • Source: Beacon Provider Relations Dept. email to providers. 3/18/20, from provider.inquiry@beaconhealthoptions.com

1. 1. Email from provider, 3/17/20:  “I just wanted to let you know that I spoke with a rep from fepblue.org this morning and she told me that telehealth services are now covered for federal employees outside of Teledoc.

2. From BCBS press release:  “FEP will waive copays for telehealth services related to COVID-19.  These actions will apply to all FEP members of the 36 U.S. and Puerto Rico-based BCBS companies
For more information on FEP’s policy changes, please visit www.fepblue.org for details on the expansion of benefits and services. Members can also call the National Information Center at 1-800-411-BLUE (2583). If you are not an FEP member and have questions about your health plan, please contact your local BCBS Company: bcbs.com/memberservices.  Contact info: Blue Cross Blue Shield Federal Employees Program Mental Health/Substance Abuse (MHSA): Phone: MHSA: 800 424-4011 (8AM – 5PM ET) Monday-Friday FAX: 866 793-0469; Other phone numbers: Phone: 800 860-2156 (8AM – 7PM ET) Monday-Friday FAX: 800 732-8318″

Source: https://www.bcbs.com/press-releases/blue-cross-and-blue-shield-federal-employee-program-waives-cost-shares-and-prior-authorizations-for-coronavirus and https://www.anthem.com/docs/public/inline/2019_FEP_15.pdf

BLUE CROSS/BLUE SHIELD OF ALABAMA

“March 13. 2020: As we continue to monitor the outbreak of the new coronavirus (COVID-19) in Alabama, we are expanding telehealth to ease access to appropriate medical services for your patients who are Blue Cross and Blue Shield of Alabama members.  The expansion of telehealth services is effective March 16, 2020, and allows clinicians to provide medically necessary services that can be appropriately delivered via telephone consultation. These actions will be effective for one month, expiring on April 16, 2020. It will be reevaluated for a continuance as needed.   This is applicable for patients who wish to receive their care remotely and limit their exposure. It can also serve as an initial screening for patients who may need to be tested for the coronavirus. For guidance on coronavirus testing, please refer to the Centers for Disease Control & Prevention and the Alabama Department of Public Health websites.  Member cost-sharing (copayments, deductibles, etc.) will apply according to the member’s contract benefits. This applies to all Blue Cross and Blue Shield of Alabama members including Blue Advantage^®.This applies to physicians and their extenders who currently receive Blue Cross reimbursement on the Preferred Medical Doctor (PMD), Physician Extender, Select and Select Extender fee schedules. Urgent care is also included; however, at this time, we are not including other provider types.

Behavioral health providers are included in this policy expansion. Some of these providers already perform telemedicine services. Under this policy, all behavioral health providers will be able to perform services telephonically. This policy expansion will expire on April 16, 2020, but be reevaluated for continuance as needed.  For behavioral health billing and coding guidelines specific to this telehealth expansion, refer to the New Directions Behavioral Health telehealth expansion memo.

New Directions will communicate additional telehealth services information to providers. To support providers who may have patients experiencing distress or anxiety, New Directions is offering a crisis hotline for the public at 1-833-848-1764.

Telehealth is appropriate for consultations and visits for either low complexity, routine or ongoing evaluation and management. This would include acute illnesses or chronic disease management that, based on the provider’s medical judgment, can be managed over the phone.

Providers should bill established-patient evaluation and management codes up to a level 3 (CPT codes 99211, 99212 and 99213). Standard documentation applies and additional billing guidelines will be posted on ProviderAccess. Claims should be filed with place of service 02 (telehealth). A modifier is not required.

Providers should only bill for telephonic consultations when the provider speaks directly with the patient. Providers should not bill Blue Cross for services when, for example, a nurse speaks to the patient, even if the provider was consulted.

If you have questions, call Provider Networks at 1-866-904-4130.”

Source: BCBS of Alabama website, viewed 3/17/20, https://providers.bcbsal.org/portal/web/pa/resources/-/resource/viewArticle/XBPIOOAUGB?frm=alabamablue.com

BLUE CROSS/BLUE SHIELD OF ARIZONA

“BCBSAZ will waive the member cost share for telehealth sessions, and expand access to telehealth and nurse/provider hotlines. Given the nature of the COVID-19 outbreak, seeking in-person medical care may lead to further spreading of the virus. BCBSAZ will encourage the use of virtual care and will also facilitate member access and use of nurse/provider hotlines.”

Source: https://newscenter.azblue.com/blue-cross-blue-shield-of-arizona-expands-support-for-coronavirus-services-and-care-waives-telehealth-cost-share-for-members/

BLUE CROSS OF CALIFORNIA (see ANTHEM BLUE CROSS OF CALIF).

BLUE CROSS BLUE SHIELD OF COLORADO

For coverage and coding info, see https://providernews.anthem.com/colorado/article/information-from-anthem-for-care-providers-that-perform-aba-services-during-covid-19-8

and check regularly https://providernews.anthem.com/colorado

BLUE CROSS OF IDAHO

BLUE CROSS BLUE SHIELD OF ILLINOIS

” March 18, 2020: Blue Cross and Blue Shield of Illinois (BCBSIL) is responding to the coronavirus (COVID-19) pandemic by offering additional coverage for telehealth visits to give members improved access to care while reducing their risk of exposure.  Effectively immediately, BCBSIL will accept telehealth billing codes for additional services, including behavioral health therapy, as described in the table below. This expansion is in addition to the new telehealth program announced on March 11, 2020, and applies to eligible BCBSIL PPO and Blue Choice PPO^SM members for medically necessary services with an in-network Illinois provider who offers telehealth services. Telehealth benefits for medically necessary services are also available to HMO members (in accordance with the details of their health plan) from providers in their medical group who offer telehealth. BCBSIL will continue to follow the applicable guidelines of the Illinois Department of Human Services and Centers for Medicare & Medicaid Services (CMS) as appropriate for Blue Cross Community Health Plans^SM (BCCHP^SM) (Medicaid Plans), Blue Cross Community MMAI Plans (Medicare-Medicaid Plan)^SM and Blue Cross Medicare Advantage (PPO)^SM members.  BCBSIL is also temporarily lifting cost-sharing for medically necessary health services delivered via telehealth. This applies to all fully insured members whose benefit plan includes telehealth benefits.  Benefits may be different for our members covered under certain employer-funded health plans, depending on the decisions their employer makes about telemedicine.  Between now and April 30, 2020, BCBSIL will continue to consider whether to extend the timeframe of this temporary cost-sharing change…. The following telehealth codes are now accepted by BCBSIL for use by health care professionals¹ authorized by Illinois State law to provide services via telehealth:

*Providers submitting claims for telehealth services using these codes must append with modifier 95.

Available telehealth visits with BCBSIL providers currently include 2-way, live interactive telephone communication and digital video consultations, which can allow members to connect with physicians while reducing the risk of exposure to contagious viruses or further illness.

As a reminder, it’s critical to check eligibility and benefits for each member at every visit prior to rendering services. Providers may connect with a Customer Advocate to check eligibility and telehealth benefits via phone, or verify general coverage by submitting an electronic 270 transaction via the Availity^® Provider Portal or other preferred vendor portal. This step will help providers determine coverage information, network status, benefit preauthorization/pre-notification requirements and other important details.

Continue to watch the News and Updates section of the BCBSIL Provider website for more information.”

Source: https://www.bcbsil.com/provider/education/2020/2020_03_16.html

BLUE CROSS BLUE SHIELD OF LOUISIANA

Letter from BCBSLouisiana 4/24/20:  “Re: Expanded Telephone Only Telehealth Services During COVID-19 Crisis: Blue Cross and Blue Shield of Louisiana continues to review our telehealth policies in response to medical service needs during the novel coronavirus (COVID-19) national emergency. We are further expanding our telehealth policies for telephone (audio-only) encounters as a replacement for office visits effective for dates of service on and after March 16, 2020. These policies will continue in effect until we are past this crisis. Expanded telephone only billing guidelines: Instead of telephone service CPT® codes, credentialed network providers are allowed to bill office visit telephone encounters as follows:

 Claims for telehealth services delivered by telephone should include the place of service code typically used by the provider (e.g., 11), along with Modifier GT or 95.

 Doctors, nurse practitioners, physician assistants and chiropractors can bill office visits for new patients using CPT codes 99201-99205. They can bill office visits for established patients using 99211-99215. As a reminder, telephone-only office visits should not include therapy services, as it would be necessary to visually observe the patient.

 Behavioral health specialists (psychiatrists, psychologists, licensed professional counselors and social workers) and registered dietitians can bill using their normal service codes for office visits…..

 As a reminder, effective April 15, 2020, individual members who buy their own healthcare coverage and those who are covered through fully insured groups have $0 telehealth audio/video or phone-only visits. Self-insured employer groups have the option to waive their members’ out-of-pocket costs. Visit the iLinkBlue (www.BCBSLA.com/ilinkblue) message board for the list of self-insured employer groups that are not waiving the member cost share. Blue Cross will notify providers when the expanded telehealth policies are no longer effective….

Be sure to visit our COVID-19 Provider Resources page, where you can easily access all of our latest provider communications. Go to www.BCBSLA.com/providers, then click on the “COVID-19 Provider Resources” link at the top of the page. We will continue to add updated information to this page as it develops. If you have any questions about the billing of COVID-19, you may send an email to our Provider Relations Department at provider.relations@bcbsla.com. Please put “COVID-19 Billing” in the subject line. Sincerely, Hiral Arges VP, Provider Relations and Contracting Network Administration in response to the COVID-19 national emergency, Blue Cross and Blue Shield of Louisiana

BLUE CROSS/BLUE SHIELD OF MASSACHUSETTS

“March 6, 2020:  Effective today, we will…. Waive co sharing for members in plans with telehealth benefits for the screening, evaluation, diagnosis, and/or suggested treatment of COVID-19. Telehealth offers convenience as well as the opportunity to avoid potential exposure to contagion. We will reach out to any employer customers without the benefit to ensure they know this option is available as well.”

Source:http://newsroom.bluecrossma.com/2020-03-06-Blue-Cross-Blue-Shield-of-Massachusetts-Expedites-Access-to-Testing-and-Care-Related-to-the-Novel-Coronavirus-COVID-19

BLUE CROSS BLUE SHIELD OF MICHIGAN

July 21, 2020:  Find Billing tips: https://www.bcbsm.com/content/dam/public/shared/documents/coronavirus/provider/alerts/telehealth-billing-changes-new-faq.pdf

April 2, 2020 – Blue Cross Blue Shield of Michigan and Blue Care Network are extending their offering of no-cost telehealth services to members with existing telehealth benefits nationally through at least June 30 to help people connect with physicians from home. Additionally, no-cost telehealth services have been expanded to include common behavioral health therapy, and most common office visit and hospitalization follow-ups.  …. Telehealth services include telemedicine and telephone-only visits with members’ own physicians and therapists that are set up by their offices, as well as Blue Cross Online Visits for members who have that service as a part of their benefits.”  See more at. https://www.mibluesperspectives.com/news/blue-cross-blue-shield-of-michigan-blue-care-network-extend-no-cost-telehealth-services-to-june-30-and-include-behavioral-health-providers/  

BLUE CROSS BLUE SHIELD OF MINNESOTA

“Blue Cross will expand access to telehealth and nurse/provider hotlines.  Given the nature of this epidemic, seeking in-person medical care may lead to further spreading of the virus. We will encourage the use of virtual care and also facilitate member access and use of nurse/provider hotlines.”  For more information go to https://www.bluecrossmn.com/about-us/newsroom/news-releases/blue-cross-and-blue-shield-minnesota-expands-coverage-coronavirus

BLUE CROSS BLUE SHIELD OF MISSISSIPPI

Source:  “Blue Cross & Blue Shield of Mississippi Novel Coronavirus (COVID-19) Pandemic Telemedicine Policy, Effective March 16, 2020” (available in provider portal):

“In response to the COVID-19 pandemic, Blue Cross & Blue Shield of Mississippi (BCBSMS) is ensuring expanded access to care, to include enhanced telemedicine coverage….Effective March 16, 2020, the BCBSMS COVID-19 Pandemic Telemedicine Policy allows Healthcare Providers …to provide medically necessary services that can be appropriately delivered via audio and/or visual consultation. The BCBSMS COVID-19 Pandemic Telemedicine Policy is effective March 16, 2020 through April 30, 2020, and will be reassessed as needed.

• Member cost-sharing (co-pays, deductibles, etc) and benefit levels will apply according to the Blue Cross and Blue Shield Member’s Health and Wellness. Benefit Plan. BCBSMS will waive the co-pay for all Network Provider covered telemedicine visits for fully-insured Members.

• Behavioral Health Providers (Psychiatrists, Psychologists, Licensed Professional Counselors, Licensed Certified Social Workers, and Board Certified Behavioral Analysts) may bill for new and established patient visits and evaluation and management codes as follows with a place of service 02 (Telehealth):

o  CPT codes 99201, 99202, 99203, 99211, 99212 and 99213

o  CPT codes 90791 and 90792

o  CPT codes 90832, 90833, 90834, 90836, and 90837

• Board Certified Behavioral Analysts may bill for Applied Behavioral Analyst therapy visits for new and established patients as follows with a place of service 02 (Telehealth):

o CPT codes 97153, 97155, 97156 and 97157

• All services must be medically necessary and documented as part of the Member’s permanent medical record, to include the amount of time spent with the patient. Patient must give consent to be treated virtually and/or telephonically and appropriately documented in the medical record prior to initiation of telemedicine.”

BLUE CROSS AND BLUE SHIELD OF NEBRASKA

“Starting Monday, March 16, 2020, all telehealth visits from providers will be paid with no member cost share for all members covered under a Blue Cross and Blue Shield of Nebraska medical plan until further notice.”

“We believe making telehealth available free of charge is in the best interests of our members during an emerging public health crisis.To register to use services provided by Blue Cross and Blue Shield of Nebraska’s preferred telehealth provider, AmWell, please follow the instructions found on NebraskaBlue.com/Telehealth.”

For more information go to https://newsroom.nebraskablue.com/how-blue-cross-and-blue-shield-of-nebraska-is-responding-to-the-coronavirus-and-what-you-need-to-know/

BLUE CROSS BLUE SHIELD OF NORTH CAROLINA

BLUE CROSS BLUE SHIELD OF OHIO

See link here: https://providernews.anthem.com/ohio/article/information-from-anthem-for-care-providers-about-covid-19-9

BLUE CROSS BLUE SHIELD OF OKLAHOMA

3/20/20 email from provider:  “I spoke with BCBS of Oklahoma today and was informed that patients [who do not have self-funded plans] will be covered for telehealth at 100% during this time. However, providers should look on their website for additional guidance on billing and codes.  Patients who have a Self-Funded plan [aka self-insured or ERISA] may not have telehealth coverage period or may only have it through MD live – at this time they are not making exceptions.  I was informed that providers need to call and verify for every patient.   Also, at this time they have no guidance that telephonic appointments will be reimbursed if the patient does not have technology for video.”

BLUE CROSS BLUE SHIELD OF TEXAS

Telehealth info (last updated 5/21/20) is available at https://www.bcbstx.com/provider/pdf/tx_using_telemed_telehealth_covid19.pdf

See also https://www.bcbstx.com/provider/covid-19-preparedness.html

BLUE SHIELD OF CALIFORNIA (NOT MHSA/MAGELLAN)

BLUE SHIELD OF CALIFORNIA, FEDERAL EMPLOYEES PROGRAM (see also Blue Cross Blue Shield Federal Employees Program)

1. Email from provider, 3/20/20: I just got off the phone with Layla from Provider Services with Blue Shield Federal Employees Program and she said that telehealth sessions are approved temporarily during the period of social distancing. She noted that the copay is NOT waived for the client unless the service being provided is specifically related to Covid-19.”

2. Email from provider, 3/20/20:  “I just got off the phone with Blue Shield of CA for Federal Employees…The patient I called on has telehealth benefits but they told me all Federal employees can now receive telehealth services.  If you use Blue Shield’s TELEDOC then their copay is waived and if you use another platform to provide services their regular copay applies.  You need to use the correct modifiers.. but the benefit people do not seem to know this.”

BLUE SHIELD OF CALIFORNIA, U.C.BERKELEY SHIP

Email from UCSHIP Contracting 3/16/19:  “Yes, you can bill for Telehealth phone calls.”  

Email 3/17/20: “Telehealth services are covered under the UCB SHIP and are the same rates regardless of the place of service (office vs telehealth).  For telehealth, providers bills the same code as if they were face to face in the office.  Please use modifier 95 to show telehealth and Place of Service code 02 for the virtual visit.  Please contact Wellfleet Member Services at (833) 302-978 for billing-related questions.”

source: UCB SHIP Contracting Blue Shield of California, 3300 Zinfandel Drive – A-1 C312F Rancho Cordova, CA 95670 UCBSHIPContracting@blueshieldca.com

“UC Berkeley is compiling a list of psychotherapists who are able to offer video/phone sessions to students during this current crisis.  If you are:

CAPITAL DISTRICT PHYSICIANS’ HEALTH PLAN (CDPHP)

“The following telemedicine services are being made available to CDPHP members at no cost-share:

• • ER Anywhere – emergency telemedicine app available to members 24/7 for consultations, triage, testing, and treatment. ER Anywhere is a safe and convenient alternative to the emergency room.
    • Members can access ER Anywhere by downloading the mobile app or calling 1-866-ER-Anywhere.
    • ER Anywhere is available to all CDPHP members, including Commercial, Medicare, Medicaid, HARP, Essential Plan, and Child Health Plus.

• • Doctor On Demand – telemedicine app available 24/7 for consultation, testing, and treatment. Doctor On Demand is a safe and convenient alternative to urgent care.
    • Doctor on Demand has a team of licensed psychiatrists and psychologists available to provide mental health services from the comfort of your home. These services are also available at no out-of-pocket costs to CDPHP members.
    • Members can access Doctor On Demand by downloading the mobile app or logging into the Doctor On Demand website.
    • Doctor on Demand is available to all CDPHP members, including Commercial, Medicare, Medicaid, HARP, Essential Plan, and Child Health Plus.

• CDPHP is also encouraging members to take advantage of telephonic consultations
  • To that end, CDPHP will be covering telephonic consults (audio and video) with participating providers for physical and mental health services.”

See https://www.cdphp.com/members/wellness/common-health-topics/cold-and-flu/corona-virus/telemedicine and see also https://www.cdphp.com/providers/get-your-job-done/covid-19/telehealth

CARE FIRST

“CareFirst is  encouraging the use of telemedicine and virtual sites of care. For telemedicine accessed through a CareFirst Video Visit, copays, coinsurance, and deductibles will be waived for the duration of this public health emergency—including behavioral health.”  For more info, click here: CareFirst

CIGNA / CIGNA BEHAVIORAL HEALTH (now EVERNORTH)

From their November 2021 newsletter “COVID-19: Interim guidance for behavioral providers:

“Many behavioral providers have contacted us about delivering telehealth sessions. While we have been reimbursing for telehealth since 2017, and will continue to do so post-pandemic, we have made some temporary revisions to telehealth requirements, and to other guidelines, to support continuity of care during this unique situation. The following changes are effective March 17, 2020 through January 15, 2022, unless otherwise noted.

Please note: As federal guidelines continue to evolve in support of the COVID-19 pandemic, we are proactively extending applicable customer cost-share waivers and other enhanced benefits, through February 15, 2021 for treatment and through January 15, 2022 for testing and testing-related services, unless otherwise mandated by the  state. This guidance is subject to change.

Evernorth Behavioral Health will continue to reimburse for telehealth after January 15, 2022, unless otherwise noted.

Coverage of behavioral telehealth sessions

Behavioral telehealth sessions are available to covered patients and are administered in accordance with their behavioral health benefits. Prior to rendering services, you should verify behavioral health benefits and eligibility for all plan types, including services administered by a third-party administrator, by calling the number on the back of the patient’s ID card. An “S” identifier on the bottom left of the card can help you identify which of your patients have services administered by a third-party administrator.

Expectations for providing telehealth sessions

As a general requirement, Evernorth-participating outpatient providers must complete an attestation to deliver telehealth sessions. During this interim period, however, telehealth attestations are not required.

While telephonic sessions are not typically covered in accordance with our medical necessity criteria, we are making an exception during this interim period. You may provide telephonic sessions to patients who do not have access to technology to participate in telehealth sessions, as appropriate.

Best practice standards indicate that providers be licensed in the state(s) where they practice and where their patient is located at the time of service. During this interim period, we understand that special considerations may need to be made, as some individuals may be displaced. We are aware that state-specific licensing requirements for the delivery of telehealth may be waived and/or loosened during this time. Evernorth will allow behavioral providers who are participating with Evernorth (and who have up-to-date credentialing) to provide in-person or virtual care in other states, through January 15, 2022, to the extent that the scope of the license and state regulations allow such care to take place. If you have questions about licensing mandates, please contact the appropriate state licensing board(s).

Billing guidance

Behavioral providers who meet telehealth requirements (see above) may deliver services via telehealth with no additional credentialing.

Individual providers and outpatient clinics

If you are an individual provider or an outpatient clinic, you may use telehealth for outpatient therapy, applied behavior analysis (ABA),* medication management, and Employee Assistance Program (EAP) services. You may offer telephonic sessions to patients who do not have access to technology to participate in telehealth sessions, as appropriate and in accordance with current legislative guidance. Include the following information on your claim form:

+ Appropriate Current Procedural Terminology^® (CPT^®) code in Field 24-D for the service(s) provided

+ Modifier 95** in Field 24-D to specify telehealth (see sample claim below)

+ Place of Service 02 in Field 24-B (see sample claim form below)

For illustrative purposes only.

Employee Assistance Program (EAP) session enhancement

Effective March 21, 2020 through September 30, 2020, Evernorth doubled the available number of free sessions any EAP customer can use for stressors and concerns in response to the impact of COVID-19 on daily lives.

Normally, EAP sessions are available on a per issue basis throughout the year. Through this enhancement, Evernorth has made available a second set of sessions (up to a maximum of 10 total) for the same issue.

Please note: If a customer did not use all of their sessions (authorized from March 21, 2020 through September 30, 2020), they have until the end of the plan year to exhaust the benefit for the respective issue. Starting October 1, 2020, additional EAP sessions may be authorized in accordance with the standard plan provisions….To confirm how many EAP sessions may be available to a customer, or to request an EAP code, call the number on back of the ID card. If your patient does not have ID card, call Provider Services at 800.926.2273.

Accelerated credentialing

If you are not a participating provider with Evernorth Behavioral Health and would like to be considered for accelerated initial credentialing, please send an email, including your need, to the appropriate Evernorth contracting team (see below). Evernorth will allow accelerated initial credentialing through December 31, 2021.

+ Individual providers. Complete the Evernorth Behavioral Health Provider Application. When Evernorth contacts you, alert us of your accelerated request….

 Continue to watch our provider website for COVID-19: Interim Guidance.

For the foreseeable future, the following platform is available, free of charge, to behavioral providers to deliver telehealth sessions: https://www.psychiatryrecruitment.org/articles/telepsychiatry-software-and-covid-19.

For more information about the delivery of telehealth in relation to COVID-19, visit: https://info.americantelemed.org/covid-19-news-resources.

 If you have questions about administering benefits for covered patients, call Provider Services at 800.926.2273.* Medical Necessity Criteria for the level of care being delivered must continue to be met.
** The “GT” modifier has been retired by the Centers for Medicare & Medicaid Services (CMS), but it still acceptable on claim forms.”

CLAREMONT EAP

“In light of the current COVID-19 Pandemic, telehealth will be a critically important means for providing care. Claremont is fully supportive of telehealth.

• If you are currently seeing clients over video, please reply to this email and confirm that you utilize a HIPAA-compliant videoconference platform.

• Please note, Facetime and Skype are not HIPAA compliant platforms.

• If you would like to work with Claremont clients over video but do not have a HIPAA-compliant platform, please reply to this email and let us know – we can set you up with a SecureVideo.com account.
Note, we do not generally allow telephone sessions except in cases of emergency. However, during the COVID-19 crisis, we are allowing our providers to offer sessions over the phone. We will reimburse the same for video, phone or in-person sessions.”

Source: email 3/13/20, “COVID-19 Announcement to Providers” from Michele Guyton, MA., Director of Provider Relations, CLAREMONT EAP, Client Services 800.834.3773, Provider services 888.699.7675
Fax 510.337.8833. mguyton@claremonteap.com www.claremonteap.com

COLORADO COACCESS MEDICAID

COMPSYCH

From Reilly Tangen, Provider Relations Specialist , in an email March 16, 2020: “In order to participate in ComPsych Telehealth, please note that the platform you use must be HIPAA Compliant. Once a HIPAA compliant platform has been established, please feel free to conduct telehealth sessions as needed. There is nothing additional required beyond this and there is no need to reply with what platform you are utilizing. If you do not already have a platform, some of the HIPAA complaint platforms that most providers use are: Simple Practice, Skype Business, Doxy.Me, Clocktree, and TheraNest. TELEHEALTH SESSIONS ARE EXACTLY THE SAME AS ANY EAP AND/OR MANAGED CARE SESSIONS; BILLING/REIMBURSEMENT IS ALSO THE SAME. THERE IS NO MODIFIER OR ADDITIONAL BILLING CODES FOR TELEHEALTH SESSIONS THROUGH COMPSYCH.”

source: Reilly Tangen, Provider Relations Specialist, ComPsych Corporation, NBC Tower – 13th Floor, 455 N. Cityfront Plaza Drive, Chicago, IL 60611.  800-557-1005, Ext. 255, Fax: 312-595-4219 providerrelations@compsych.com

From Christine Ulrich at ulrich@compsych.com, email March 16, 2020: “ComPsych providers are allowed to provide telehealth services to their clients for both EAP and Managed Care. No additional code will be needed.”

CONCERN EAP

“We have been getting questions from many providers re: how to respond to requests for phone/video counseling if clients are uncomfortable coming into the office. Here are our thoughts and suggestions:

• If you have a current client who asks about this, and you are comfortable providing phone/video services, and you have a HIPAA compliant phone/video platform from which to provide clinical services, it is fine with Concern that you offer these services. You will bill us at the usual session rate in the same manner as you would face-to-face counseling.
o HIPAA compliant video platforms include (but are not limited to) Simple Practice, Doxy.me, Zoom, Theralink, and VSee. We do not endorse one over the other. Some have a fee, some do not.
o Please check with your phone carrier to determine if your phone line is HIPAA compliant. Google Voice for G suite is HIPAA compliant.
o If you have questions or would like to consult about the clinical appropriateness for a particular case, please call us at 800-344-4222 and ask for your clinical supervisor or the clinical manager on call.
o Phone and video sessions are 45-50 minutes in length and replace a face-to-face visit. Please be sure to conduct sessions in a private, professional space where there are no interruptions or distractions. You may need to clarify with clients that they are part of the EAP benefit level and “count” the same as a face-to-face session.
• New clients referred to you may be requesting face to face counseling. However, because the COVID-19 situation is changing daily, you may get questions about remote services from these clients as well.
o If you are comfortable offering telephonic or video counseling, please do so. If not, please refer these new cases back to Concern.
• New clients who call Concern specifically asking for video or telephonic counseling will be referred only to counselors who indicate they are comfortable providing these services as well as face to face.
• As always, if you are unavailable or out of the office, please call provider relations and let us know so we can make a note of it and not send referrals your way.

From, The Concern Network Team (1-800-344-4222) — Kiersten Daniel-Baca, LCSW, Director of Clinical Services, 650-940-7061, Kiersten_danielbaca@concernhealth.com; Margot Brown, PsyD, Clinical Services Manager, 650-988-7513, Margot_brown@concernhealth.com; Susan Zweig, LCSW, Clinical Services Manager, 650-988-7422, Susan_zweig@concernhealth.com”

Source: Source: Email on 3/13/20 to Concern Providers

EMPATHIA

“In order to give our members flexible options to access care, which can help reduce the spread of infection, we are expanding our services to include video and telephone telehealth services during the duration of this state of emergency. Effective March 17, Empathia will cover telephone and video “virtual” visits with members. Providers must follow all state legal and ethical provisions of EAP telehealth services including ensuring that the enrollee is appropriate for these services. We ask all providers to complete a brief survey (https://empathia.formstack.com/forms/telehealth_attestation) to notify Empathia of the types of services you will be offering during these critical times. In order to conduct sessions via video, providers must complete the EAP telehealth attestation for which will appear below the service delivery method once “Video sessions (telehealth)” is selected. Phone and video visits will be reimbursed at the same rate as a regular in-person visit.  For any additional questions or concerns, please reach out to field operations at 877-844-8693 extension 6.”

Source:  3/17/20 Email to providers from Tim Sumiec, tsumiec@empathia.com, signed by Carol Wilson CEO, Empathia, Inc. , N17 W24100 Riverwood Drive, Suite 300 Waukesha, WI 53188  and Patti Ackermann, CEO/CFO, Empathia Pacific, Inc., 5234 Chesebro Road, Suite 201, Agoura Hills, CA 91301

EMPIRE BLUE CROSS BLUE SHIELD OF NEW YORK

Get information at: https://providernews.empireblue.com/article/information-from-empire-for-care-providers-about-covid-19-updated-april-22-2020

EVERNORTH (formerly known as CIGNA):  See CIGNA

FIRST HEALTH / COFINITY

RE: Telemedicine and Legislative updates: “We know that you are seeking creative solutions to safely treat your patients during the COVID-19 pandemic. One such method to treat patients is through Telemedicine visits. We’ve got answers to some of your most basic questions about virtual visits, like how to bill. And, we can tell you who can help determine coverage. Before accepting any telemedicine visits, you’ll want to check with the payer to determine if the visit will be covered. Simply call the payer number listed on the patients’ ID card. We polled over 100 of our top clients and were able to determine that most of them do cover Telemedicine. Those who don’t are exploring it now, in order to support the COVID-19 pandemic. There are still payers who haven’t responded or aren’t setup to accommodate Telemedicine at this time. Since we don’t have the ability to guarantee which payers cover Telemedicine, we’re encouraging you to call the payer prior to providing services, to validate coverage. They’ll be able to tell you if there are any co-pays and/or coinsurance to collect for the visit.Once you’ve confirmed that the Telemedicine Visit will be covered, and you’ve seen your patient. You’ll want to be sure to bill with place of service code ‘02’. You can check the CMS.GOV website for more detailed guidelines.You’ve probably heard that on Wednesday, March 18 the Trump administration announced that the Department of Health and Human Services will allow all physicians and other medical professionals to practice across state lines. This legislation will let you and your colleagues care for patients across state lines during the COVID-19 pandemic. — source: Kara Dornig, Executive Director First Health Network email to providers 3/25/20

FLORIDA BLUE

Updated May 1, 2020:  According to the Florida Blue website, virtual vista will be covered at the member’s current cost share (that is, current copay/coinsurance).  The Place of Service code is 02 for telehealth (for facilities use 11).  Bill with Gt or 95 modifier.  Only Florida Blue and New Directions contracted behavioral health providers and outpatient facilities are able to bill.  Effective 3/15/20.

— Source: https://www.floridablue.com/sites/floridablue.com/files/docs/COVID-19_Billing_Guidelines_05.01.20_v2_Approved.pdf

HEALTHNET OF CALIFORNIA

“For commercial and Medi-Cal plans:

• • For Commercial:
    • Use the normal Place of Service code (11, 23, etc.) – excluding FQHC/RHCs
    • Use appropriate modifiers – excluding FQHC/RHCs
      • Modifier 95 (Synchronous, interactive audio and telecommunications systems), OR
      • Modifier GQ (Asynchronous store and forward telecommunications systems)
  • For Medi-Cal:
    • Use Place of Service code 02 (Telehealth) – excluding FQHC/RHCs
    • Use appropriate modifiers, when applicable – excluding FQHC/RHCs
      • Modifier 95 (Synchronous, interactive audio and telecommunications systems), OR
      • Modifier GQ (Asynchronous store and forward telecommunications systems)

The same amount of reimbursement will be provided for a service rendered via telephone as they would if the service is rendered via video provided the modality by which the service is rendered (telephone versus video) is medically appropriate for the member.”

— Source (assessed June 13, 2021): https://www.healthnet.com/content/healthnet/en_us/covid-19-updates/providers.html#alerts.html

HUMANA

“Humana has created a website to keep our providers updated on our organizational response to COVID-19 and provide information and resources related to claims payment, member responsibility, etc. Please click on the link: https://www.humana.com/provider/coronavirus.    See also

https://docushare-web.apps.cf.humana.com/Marketing/docushare-app?file=3934255 , https://www.humana.com/provider/coronavirus/covid19-benefits , and FAQs: https://www.humana.com/coronavirus/coverage-faqs

1. 2019 CMS Guide to Telehealth Services MLN Booklet — Humana follows CMS guidelines.
2. Approved TeleHealth Policy.

There should be no need to amend your provider contracts as these codes should be on the 005-33x fee schedule.  As always we recommend that you verify members eligibility and benefits and or contact Customer Service for more guidance.  Responsibility for payment shall be subject to but not limited to membership eligibility, benefit limitations and coordination-of-benefits rules, etc.  Here is also a website where the Telehealth policy is so you can check in case Humana updates the policy at any time.  Here is the link , search by keyword “telehealth” https://www.humana.com/provider/medical-resources/claims-payments/claims-payment-policies   “

Source:  3/16/20 email from Behavioral Health Provider Services, Humana Behavioral Health Network, 2001 W. John Carpenter Freeway Irving, TX 75063, T 800-890-8288, F 833-931-0662, behavioralhealthproviderservices@humana.com

KAISER:  For Kaiser Clients handled by Magellan, see “Magellan”; For Kaiser clients handled by Beacon, see “Beacon”

KGA (EAP)

“As you are likely aware, concerns regarding COVID- 19 are causing citizens to take extra precaution in order to decrease risk of exposure. We understand that for this reason many clinicians will begin to offer counseling via phone or video as opposed to in-person sessions. We want to inform you that we encourage these efforts and many of our clients would be interested in the option of virtual counseling during this time. If you decide to make arrangements for online counseling, the EAP billing process will remain the same. As our office will be closed for the next few weeks and our staff will be working from home, it will be best to email billing invoices as opposed to faxing. Click here to email us. If you do fax the invoice we will be unable to reimburse you until our office is open.   Please let us know if you plan to offer all counseling sessions online for the foreseeable future. This will enable us to inform potential referrals. If you have any questions or concerns about this, please contact our Counseling Assistants at 800-648-9557 and ask for Tiffany or Michelle.”

LIFEWORKS BY Morneau Shepell

1. From email to affiliates 3/17/20:  “In light of the current concerns surrounding COVID-19, we are seeing a significant increase in requests for tele counselling in lieu of in person appointments.  We want to offer support both to you as a LifeWorks Counselor, as well as to our clients who request a counseling service. You may have concerns about clients in your office, and clients may experience increased anxiety about being in a public place.  We encourage you to check with your licensing board, and if permissible, you have our support and endorsement to provide counseling sessions telephonically or using a HIPAA compatible Video platform.  (Please note that Skype and FaceTime are NOT HIPAA compatible and should not be used.)  …  If you are no longer able to see clients in person in your office and are moving exclusively to tele-counselling, please be sure to inform your clients and update your voicemail with a message that you are only doing appointments via telephone. If you are not able to reach all of your clients, be sure to leave a sign on your office door saying that you have attempted to reach everyone to move to tele- appointments and asking that they reach out to you by phone or email to reschedule.

We will continue to monitor events regionally, and will make any adjustments to these plans as necessary based on local circumstances. For all concerns, please connect with us at PNS_inquiries@morneaushepell.com”

2. From email to a provider 3/17/20: “Because of the COVID-19 pandemic, we are temporarily allowing our Affiliates on both the LifeWorks and Morneau Shepell sides to take on Tele-Support and Video Counseling if they do not want to do In-Person Counseling.  We allow our Affiliates to conduct Video Counseling sessions through a HIPAA compliant platform.  Reimbursement would be the same as your In-Person rate at this time.  When it comes to billing, if you receive an in-person case, but do Tele-Support/Video, you should still indicate the session as In-Person.”

Source: Kourtney Julious, Affiliate Specialist, LifeWorks by Morneau Shepell  T: 312.807.0518  134 North LaSalle Street, Suite 2200, Chicago, IL 60602
LifeWorks

3  From email to providers 3/18/20 from Mailroom@morneaushepell.com: “During this unprecedented time, LIfeWorks by Morneau Shepell continues to monitor the rapidly changing impact to our communities as a result of the COVID-19 pandemic.  First and foremost, please know that our thoughts and best wishes remain with you, your loved ones, and the clients you serve on our behalf.  We recognize the increased need for flexibility and understanding during this time.  Please consider the following:

• • Use Tele Health services whenever possible and appropriate.  You may need to check with your licensing or regulatory board to confirm this modality has been approved during the pandemic.
  • Video sessions on a secure platform are acceptable.  (Note, Skype and Face Time are NOT compatible with HIPAA regulations and should not be used.)
  • If you are a current and credentialed Tele or Video Support counselor in the LifeWorks network, use your current process to bill for sessions.
  • If you are currently a face to face (FTF) counselor, it is okay during this time to bill for Tele and Video Sessions as if they were a FTF appointment.
  • Please feel free to contact us at pns_inquiries@morneaushepell.com with any questions or concerns.”

LYRA

1. Email to providers March 19, 2020: “Given current CDC guidelines, which recommend social distancing to prevent community spread of coronavirus, we encourage providers in areas highly impacted by COVID-19 to consider moving their in-person sessions to video sessions, provided video is clinically appropriate for their clients. If you would like to temporarily offer video sessions during this public health situation, please contact us at providers@lyrahealth.com. Once we receive your request, we can refer new clients who designate a preference for video to your practice.  Even if your area is not highly impacted by COVID-19 and you are new to video, we encourage you to take steps to prepare your practice to see clients by video, if and when appropriate.

Best Practices to Consider

• • If you are able to offer video sessions, be sure to use a HIPAA-compliant video platform.
  • Choose a private setting that is free of distractions.
  • Ask clients for a contact number in advance, in case your connection is disrupted.
  • Ask clients for the address where they are taking the session in case of a clinical emergency.
  • Learn more about our video therapy resources here.

Once the public health concern has stabilized, please plan for a return to in-person sessions. Lyra’s network of highly skilled, evidence-based in-person providers is a primary reason that employers choose the Lyra benefit for their employees.  Lastly, we encourage you to follow the recommendations of local, state and federal government agencies as you take preventive measures to keep yourself and your clients healthy.  Please contact us at providers@lyrahealth.com if you have any questions about care for your Lyra clients.”

2. Email 3/19/20 from Lyra after author contacted providers@lyrahealth.com and asked to be placed on video list:  “Thank you for reaching out. We have enabled your profile for video sessions. We appreciate you making accommodations for Lyra clients at this time…

1) If you are planning on conducting video therapy sessions in the short term (during the crisis), Please take a moment to review Lyra’s requirements and resources for video therapy here: https://provider-support.lyrahealth.com/hc/en-us/articles/222972387-Become-a-Video-Therapy-Provider

2) Please note that we will NOT be removing your office address from your profile. If a client reaches out for in person sessions, we ask that you please tell your client that you are not able to meet in person and that you send them instructions on how to do sessions online. We do not have the ability to make changes to your profile bio to reflect this at this time.

1,  Information about Magellan coverage for telehealth can be found at http://www.magellanprovider.com/media/154064/covid_qa.pdf

Note:  You will note that Magellan is asking therapists to use the Place of Service Code 02 for all Telehealth Services, however, it is asking that you use the modifier 95 or GT when using a HIPAA-compliant video platform, and the modifier GQ when doing a phone session or using a non-HIPAA-compliant video platform.

1. Email received by provider 5/4/20 regarding Magellan Kaiser clients:
   

   Recently, Magellan Healthcare* learned that non self-funded Kaiser Permanente members received a letter about a change in how they are to pay their cost share. The notice indicated that effective May 1, 2020, Magellan providers would begin collecting cost share from members. This is not accurate. Refer these members to Kaiser Permanente at 1-800-464-4000. You should not collect cost share from non self-funded members, until Magellan notifies you otherwise.  Any claims for Kaiser Permanente members will continue to be reimbursed as they are today. Non self-funded members Magellan providers should not collect cost share (copayment and deductible) from non self-funded Kaiser members.  Kaiser  is responsible to collect the cost share (copayment and deductible) from these members until further notice. Self-funded members Magellan providers should collect cost share for Kaiser Self-Funded Plan members only at the time of the member’s appointment. Please refer to the Quick Reference Guide posted to the Kaiser Permanente page of our provider website for more detail. If you have any questions, you may email us at CaliforniaProvider@MagellanHealth.com. — from Nardy Creekbaum, Senior Manager, Network Development

   2. Email from Magellan to providers 3/19/20:  “Like you, we are deeply concerned about the health and safety of people everywhere as we face the COVID-19 crisis. To support you in ensuring Magellan members get the care and services they need, effective March 18, 2020, during this national state of emergency, we are taking various measures, such as:

• • Waiving requirements to provide services via telehealth (e.g., attestations).
  • Helping providers access a telehealth platform.
  • Allowing sessions via telephone if telehealth is not possible.
  • Permitting intensive outpatient (IOP) and partial hospitalization programs (PHP) to deliver services via telehealth, if feasible.

Visit MagellanProvider.com/crisis for details in our list of provider questions and answers pertaining to these topics and more. Please bookmark and refer to this webpage and Q&As frequently as we will continually update them.”

Source:  Magellan Healthcare email 3/19/20 to providers from providernotices@magellanhealth.com,  www.MagellanProvider.com,  14100 Magellan Plaza, Maryland Heights, MO 63043

2. Information from Magellan website:  “The following CPT codes can be billed by physicians/psychiatrists, psychologists, master’s level, and clinical nurse specialists.” (with modifier)

90791 Psychiatric Diagnostic Evaluation – no medical services GT or 95
90832 Psychotherapy with patient, 30 minutes GT or 95
90834 Psychotherapy with patient, 45 minutes GT or 95
90837 Psychotherapy with patient, 60 minutes GT or 95
90839 Psychotherapy for Crisis, initial 60 minutes GT or 95
+90840 Psychotherapy for Crisis, additional 30 minutes GT or 95
90846 Family Psychotherapy (without the patient present), 50 minutes GT or 95
90847 Family Psychotherapy (conjoint psychotherapy) (with the patient present), 50 minutes GT or 95
+99354‐99355 Prolonged Physician Service with Direct (face‐to‐face) Patient Contact, Office/Outpatient GT or 95
+90785 Interactive Complexity Add‐On GT or 95

• Telehealth Services Provider Attestation: Magellan requires completion and return of this document for provision of all telehealth services.
• Telehealth is defined by Magellan as a method of delivering behavioral health services using interactive telecommunications when the member and the behavioral health provider are not in the same physical location. Telecommunications MUST be the combination of audio and live, interactive video.
• CPT/HCPCS codes performed by telehealth distant providers must be billed with the GT or 95 modifier.
• Organizational providers billing professional services should bill the license level modifier in the first modifier field and the telehealth modifier in the second modifier field.
• HCPCS code Q3014 performed by telehealth originating site providers should not be billed in conjunction with the GT or 95 modifier; some accounts may require separate authorization for this HCPCS code to be reimbursed.
• Place of Service code: All telehealth claims should be billed with the “02” POS code.

Source: https://www.magellanprovider.com/media/51605/telehealth_billing.pdf

MANAGED HEALTH NETWORK (SEE MHN)

MEDICA

MEDI-CAL (HEALTHNET)

• • “For Medi-Cal:
    • Use Place of Service code 02 (Telehealth) – excluding FQHC/RHCs
    • Use appropriate modifiers, when applicable – excluding FQHC/RHCs
      • Modifier 95 (Synchronous, interactive audio and telecommunications systems), OR
      • Modifier GQ (Asynchronous store and forward telecommunications systems)

The same amount of reimbursement will be provided for a service rendered via telephone as they would if the service is rendered via video provided the modality by which the service is rendered (telephone versus video) is medically appropriate for the member.”

— Source (assessed June 13, 2021): https://www.healthnet.com/content/healthnet/en_us/covid-19-updates/providers.html#alerts.html

MEDICARE

For Medicare updated info, see this release updated 5/20/20 at https://files.constantcontact.com/2c1fe85b401/d3337264-2858-4a74-b7ff-33ac3f71a28d.pdf

Note: While a 3/31/20 CMS announcement stated that therapists should use Place of Service code 02 and Modifier 95, on 4/3/20 this was corrected in a release that stated: “When billing professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with:

• • Place of Service (POS) equal to what it would have been had the service been furnished in-person
  • Modifier 95, indicating that the service rendered was actually performed via telehealth

–source:  “Billing for Professional Telehealth Distant Site Services During the Public Health Emergency, Revised, 4/3/20″.   https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-03-mlnc-se#_Toc36815181

2. From “Medicare telehealth billing Update,”  from the American Psychological Assn., dated 4/6/20:

“The Centers for Medicare and Medicaid Services (CMS) has once again issued new guidance on the delivery of health care services during the COVID-19 public health emergency.  Effective March 31, 2020, psychologists providing services through telehealth should use the place of service (POS) that would have been reported if the service had been furnished in-person. CMS is making this change to identify when it is appropriate to pay a nonfacility fee, rather than a facility fee which would have automatically been included under POS 02.  To illustrate, a psychologist who would have seen patients in a private office should use POS 11. Those who would have treated the patient in a clinic or skilled nursing facility should use the corresponding POS.  All claims for telehealth services should now include modifier 95.

see more at https://www.apaservices.org/practice/clinic/covid-19-medicare-telehealth-billing

3.  Get latest information on coverage at https://www.medicare.gov/medicare-coronavirus

4. 4/30/2020 Further Expand Telehealth in Medicare:  “For the duration of the COVID-19 emergency, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.  [Note from BG:  However, when you look at list of CPT codes covered for Medicare telehealth (see #5 below), I don’t see any for psychotherapy with therapist.]

CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

As mandated by the CARES Act, CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics. Previously, these clinics could not be paid to provide telehealth expertise as “distant sites.” Now, Medicare beneficiaries located in rural and other medically underserved areas will have more options to access care from their home without having to travel”

–source: Trump Admin.Issues 2nd Round of Sweeping Changes to Support U.S Healthcare System During COVID-19 Pandemic:  https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid

5. If you are interested in coverage for phone sessions, it is more confusing than it may seem:  Read this article at https://www.terryfletcher.net/2020/04/08/telehealth-billing-coding-for-non-video-phone-calls/

See also 3/17/2020 telehealth FAQ at: https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

MHN

OPTUM — SEE UNITED HEALTH CARE/ UNITED BEHAVIORAL HEALTH/OPTUM

OSCAR HEALTH

“We continue to offer $0 telemedicine services (*available on most Oscar plans. We ask members to look at their plan details for more information). Telemedicine is a great first option for people who think they could have coronavirus. Our telemedicine doctors can help you determine your risk factors and direct you to the right place for testing, if they think it is necessary.”

Source: https://www.prnewswire.com/news-releases/oscar-shares-update-on-covid-19-301019312.html

PIEDMONT COMMUNITY HEALTH PLAN

“Until June 30, 2020, Piedmont is permitting online mental health counseling to all members at in-network providers. Online means interacting with a mental health counselor by phone or via a computer”

” Effective immediately, for all Commercial Fully-Insured Plan and Exchange Plan members, Piedmont will waive out-of-pocket member costs for telehealth services at Centra 24/7, and permit online mental health counseling to all members at in-network providers.  The above benefits are available for services performed through June 30, 2020.”

Source:  download COVID-19 FAQ Press Release at Piedmont’s website

PREMERA BLUE CROSS BLUE SHIELD OF ALASKA

PREMERA BLUE CROSS OF WASHINGTON

See https://www.premera.com/wa/provider/coronavirus-faq

Updated June 2021: “Premera will be extending the payment of telehealth visits at the in person allowed amount, during the national public health emergency, beyond September 1, 2020 as previously communicated. For providers who are delivering services via telehealth, Premera will require providers to continue use the correct telehealth place of service (POS) 02 with the procedure code appended with either modifier 95 or GT. Claims with modifiers indicating they were telehealth, if billed with POS 11, will be rejected up front and will require the correct POS to match the service billed. We will no longer accept POS 11 for telehealth services.”

REGENCE BLUE SHIELD OF IDAHO

Regence is “easing access through virtual care:Regence is a leader in providing alternative, low-cost care solutions such as virtual office visits through telehealth and secure text/chat with doctors and nurses. These solutions enable access to virtual care quickly and conveniently while minimizing the spread of infection and easing pressure on providers’ offices and emergency rooms. Members can contact customer service or log-in to regence.com to learn about the method that’s best for them and their plan.”

NOTE: I have not been able to find telehealth coding information for this plan, but it is likely that it is following the path of the other Regence plans, which want the 11 Place of Service code and 95 GT (see Regency of Oregon, below)

For information: http://news.regence.com/releases/regence-blueshield-of-idaho-to-cover-cost-of-coronavirus-covid-19-testing-for-members

REGENCE BLUE CROSS SHIELD OF OREGON

Latest info is at https://www.regence.com/provider/library/whats-new/covid-19#temporary-updates-to-telehealth

IMPORTANT CODING CHANGE!!

“For dates of service through June 30, 2021:  For claims to process correctly as expanded telehealth and for you to receive reimbursement consistent with an in-office visit, you must use the place of service (POS) where the services would have normally occurred(including POS 11; excluding POS 02) AND Modifier 95 to indicate that the services were rendered via telehealth.  Telehealth services are covered when conducted via audio or video…..

For dates of service on or after July 1, 2021:  Claims for eligible telehealth services must be billed with POS 02 and modifier GT. Modifier 95 will no longer be accepted as an indicator for telehealth services.  Telehealth services may be conducted via audio or video.”  — assessed June 12, 2021

REGENCE BLUE CROSS SHIELD OF UTAH

IMPORTANT CODING CHANGE!!

“For dates of service through June 30, 2021:  For claims to process correctly as expanded telehealth and for you to receive reimbursement consistent with an in-office visit, you must use the place of service (POS) where the services would have normally occurred(including POS 11; excluding POS 02) AND Modifier 95 to indicate that the services were rendered via telehealth.  Telehealth services are covered when conducted via audio or video…..

For dates of service on or after July 1, 2021:  Claims for eligible telehealth services must be billed with POS 02 and modifier GT. Modifier 95 will no longer be accepted as an indicator for telehealth services.  Telehealth services may be conducted via audio or video.”

— see source (accessed June 12, 2021) : https://www.regence.com/provider/library/whats-new/covid-19/covid-19-telehealth#Expanded-telehealth

REGENCE BLUE SHIELD OF WASHINGTON

Coding highlight below:

IMPORTANT CODING CHANGE!!

“For dates of service through June 30, 2021:  For claims to process correctly as expanded telehealth and for you to receive reimbursement consistent with an in-office visit, you must use the place of service (POS) where the services would have normally occurred(including POS 11; excluding POS 02) AND Modifier 95 to indicate that the services were rendered via telehealth.  Telehealth services are covered when conducted via audio or video…..

For dates of service on or after July 1, 2021:  Claims for eligible telehealth services must be billed with POS 02 and modifier GT. Modifier 95 will no longer be accepted as an indicator for telehealth services.  Telehealth services may be conducted via audio or video.”

source accessed June 12, 2021– https://www.regence.com/provider/library/whats-new/covid-19#temporary-updates-to-telehealth

SAN FRANCISCO DEPT. OF PUBLIC HEALTH PPN

“At this time of the advisability of social distancing due to COVID, the BHS COVID Response Team has approved today that PPN therapists can see their clients over the phone for their regular counseling appointments, instead of face to face, and to be able to bill us Individual Psychotherapy/Counseling and other mental health services for these sessions rendered over the phone.  According to Maria Barteaux, [maria.j.barteaux@sfdph.org]., they are to “use the correct Place of Service code the claims they submit to SFMHP,” and Maria says that “the CMS POS code we use is ‘98’ = Phone.”

Source: 3/16/20 email from Edwin Batongbacal, LCSW, Director, Adult and Older-Adult Systems-of-Care Behavioral Health Services, San Francisco Department of Public Health. edwin.batongbacal@sfdph.org

“Edwin and I both stated that MH services can be provided over the Phone.   If you are submitting Fee-for-service claims to the SF Mental Health Plan for services rendered over the Phone, please use Place of Service code ‘98’.” [Note: I checked with Maria to be sure this was correct, and she insisted it was].

Source: 3/16/20 email from Maria Jimenez Barteaux, CBHS Billing /SFMHP Claims, Central Administration – Fiscal, SF Department of Public Health, City and County of San Francisco, 1380 Howard Street, Rm. 314, San Francisco, CA 94103, Phone: (415) 255-3536       Fax:(415) 252-3035, Maria.J.Barteaux@SFDPH.org

Others on email thread:  Ellen Lee Zhou, Data Manager for SFPPN, San Francisco Health Network, 1380 Howard Street, Room # 219, San Francisco, CA 94103, ellen.zhou@sfdph.org,  Phone: 415-255-3415 Fax: 415-252-3057
Gloria Frederico (DPH) gloria.frederico@sfdph.org

TRICARE WEST

1. TRICARE is asking for Place of Service code 11 and modifier GT or 95 on claims if you provided telehealth sessions from your home or office.  For complete telehealth billing Tips, click here ; for Telehealth coverage information, click here
2. Sept 2, 2020 from a provider:  “I received an update from Tricare West. I was informed today that Telehealth sessions that have occurred since May 12th will not have a copay. They don’t have an end date to this update.”

UNITED BEHAVIORAL HEALTH/OPTUM (see also UNITED HEALTHCARE below)

1. Latest policies can be found here: https://www.providerexpress.com/content/ope-provexpr/us/en/COVID-19_Provider_Updates/COVID-19_Reimbursement_Guidelines.html

2. From an email sent from United HealthCare to providers on 6/17/20:

“Extending Temporary Telehealth Expansion and Reimbursement Through Sept. 30, 2020:   To help you deliver care and be reimbursed for telehealth services, for certain markets and plans we’re temporarily continuing to waive the Centers for Medicare & Medicaid Services (CMS) originating site requirement for members through Sept. 30, 2020.*

And, UnitedHealthcare will temporarily reimburse providers for telehealth visits at parity with the rate they would receive for an in-person visit.

Depending on whether a claim is for a Medicare Advantage, Medicaid, Individual and fully insured Group Market health plan members, those policies may require slightly different modifiers, date of service limitations or place of service indicators for a telehealth claim to be reimbursed. For more details, please visit UHCprovider.com/covid19.

Extending Telehealth Cost Share Waivers : UnitedHealthcare is also continuing its expansion of telehealth including temporarily waiving member cost share for telehealth visits for medical, outpatient behavioral, physical, occupational and speech therapy, chiropractic therapy, home health, hospice and remote patient monitoring services, with opt-in available for self-funded employers.

• • For COVID-19 in- and out-of-network telehealth services, UnitedHealthcare is waiving cost share through the national public health emergency period.
  • For COVID-19 in-network only telehealth services, UnitedHealthcare will extend the cost share waiver from July 25, 2020 through Sept. 30, 2020.*
  • For non-COVID-19 in-network only telehealth services, UnitedHealthcare will extend the cost share waiver through Sept. 30, 2020.*

* This date is subject to change based on direction from CMS.

Updated Program Dates
Keep track of which temporary measures are expiring and which are being extended with our updated Summary of COVID-19 Dates by Program. This handy reference guide can be shared with your office staff to help with administrative tasks.”

2.  From online Provider Express last updated May 21st:

“Billing Guidelines [for Private Plans]:  Optum Behavioral Health will reimburse telehealth services which use standard CPT codes for outpatient treatment and a GT, GQ or 95 modifier for either a video-enabled virtual visit or a telephonic session, to indicate the visit was conducted remotely.  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). Contracted providers can bill with either the POS they would have used had the service been furnished in person or they can use POS 02 and they should bill using the appropriate CPT code as indicated on their fee schedule.”  Remember, Medicaid and Medicare may have different coding, see the following link for more on coding: https://www.providerexpress.com./content/ope-provexpr/us/en/COVID-19_Provider_Updates/COVID-19_Reimbursement_Guidelines.html

 3. Another helpful source, FAQs for OPTUM providers about telehealth visits, last updated June 24:   click here 

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List copyright 2020 Barbara Griswold, LMFT, Navigating the Insurance Maze: The Therapist’s Complete Guide (www.theinsurancemaze.com)

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READ MY LATEST ARTICLE ON BILLING FOR TELEHEALTH HERE

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Please contact me with addictions/corrections, I’ll be updating this regularly, so check back for updated info.  

Disclaimer: No information here should be construed as a substitute for checking coverage on a particular client with a particular plan for the exact services you are providing.   Some clients (especially those with self-insured or ERISA plans) may have differing coverage, and some plans may not cover telehealth for psychotherapy.  In addition, this is a compilation of information gained from other sources, and I cannot be responsible for the accuracy of the information provided to me..