Alert….Telehealth Coverage Updates
The COVID pandemic expanded telehealth coverage availability across almost all health plans (Commercial/Medicaid/Medicare) by eliminating originating site criteria and expanding codes covered in a telehealth setting. For the most part, we’re still in a holding pattern on current coverage guidance; based on either State or Federal Public Health Emergency declarations or plan coverage decisions through 12/31/2020. Below are the most recent policy updates/coverage decisions for Medicare/Medicaid/the major payors. For UHC and Anthem commercial plans, the cost-share waivers for telehealth have already ended but for the other carriers, they will remain in place through the end of this year. Obviously, we’re seeing an uptick in COVID now which could well extend these policies past the end of this year. From a more general perspective, we do believe that most payers will keep some telehealth accommodation going forward as the genie is out of the bottle at this point.
Medicare Telehealth
CMS will continue covering expanded telehealth services through the COVID-19 Public Health Emergency. On 10/23/2020, Secretary Azar expanded the PHE for another 75 days through January 2021. Based on current COVID uptick, there is every reason to believe it will be extended again in January. Traditional Medicare and Medicare Advantage plans should continue following the same expanded benefit for the duration of the PHE.
Medicaid Telehealth
Traditional Medicaid and the CMOs will maintain the expanded telehealth coverage through the end of the state Public Health Emergency declaration. The current PHE will run through December 9, 2020.
Aetna
Telehealth expanded coverage remains in place. Through 12/31/2020, Aetna will continue waiving cost-share for in-network, telehealth medical services for commercial and Medicare plans. For commercial plans, self-insured business can opt-out of the waivers and still require patient cost-share. On September 30, 2020, telephonic only visits without video connection reverted to standard pricing mechanisms (from March through September, telephone only visits paid the same as standard telehealth visits).
Anthem
Anthem’s cost-share waivers ended for commercial plans on 9/30/2020; however, the cost-share waiver will remain in effect through 12/31/2020 for Medicare Advantage plans.
Cigna
Cigna’s enhanced telehealth rates will remain in place through December 31, 2020 and cost-share waiver through January 21, 2021. On their secure website, they have a new virtual care policy that will launch on January 21, 2020 which you should access for any updates.
- In an effort to make it as easy as possible for our customers to access timely and safe care, while ensuring that providers can continue to deliver necessary services in safe settings, Cigna will allow providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19, through December 31, 2020.
- This means that providers can perform services for commercial Cigna medical customers in a virtual setting and bill as though the services were performed face-to-face.
- Providers should bill using a face-to-face code, append the GQ, GT or 95 modifier, and use the POS that would be typically billed if the service was delivered face to face (e.g., POS 11).
- Providers will be reimbursed consistent with their typical face-to-face rates.
- Providers can also bill code G2012 for a 5-10 minute phone conversation, and Cigna will waive cost-share for customers until January 21, 2021. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time.
- Customer cost-share will be waived for COVID-19 related virtual services through January 21, 2021.
- Please review the “Virtual care services” frequently asked questions section below for additional information about our interim COVID-19 virtual care guidelines.
- Effective January 1, 2021, we will implement a new Virtual Care Reimbursement Policy. Please visit CignaforHCP.com/virtualcare for additional information about that policy.
Humana
Humana’s cost-share waivers for telehealth visits will also expire on 12/31/2020. No additional changes have been announced regarding the expanded coverage for services.
United Healthcare
UHC’s coverage is now being further defined by plan type (i.e. Medicare vs commercial). The full link is https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-services-telehealth.html. For commercial plans, the cost-share waivers are still in effect for primary care but have ended for specialist providers; and the cost-share waivers for all providers will continue through 12/31/2020 for Medicare Advantage plans.
If you have any questions, please let us know.
Thanks!