Telehealth

CARES Act Overview | Small Business Financial Assistance | HIPAA Implications
Telehealth | Medical Supplies | Helpful Resources

The embedded grid provides information as to effective date of expanded telehealth coverage; duration of policy; waiver of cost-shares; billing guidance; any noted exclusions; and codes covered where it is explicitly listed by the plans.

As you’ll see from the grid; the billing guidance is varied without a consistent policy that should be applied. For example, Cigna’s systems do not have the capability to administer telehealth Place of Service or Modifiers without reducing the payment amount; therefore, any Cigna telehealth visits should be billed as regular face-to-face encounters.

That said, in terms of your operations, there is more consistent guidance for you on the initiation of these services:

Verbal consent must be granted by the patient: please mark date, time and person granting this consent in your visit notes.
Many telehealth codes require an audiovisual connection. Under current guidelines, this can include Skype; Facetime; etc. We again recommend doxy.me as a viable platform based on their current use by Georgia’s DPH and positive feedback from members.
Prescription guidelines have been relaxed; allowing for early refills and encouraging 90-day fills for non-controlled substances. Additionally, many payers offer home delivery of medications which may be useful during this time.

Please let us know of any questions that you have regarding these services and how to operationalize telehealth within your practice. As we’ve shared, almost all of the major payers also offer their own telehealth platform; therefore, we encourage you to initiate your own program in order to maintain your patient relationships and keep patients engaged for when this pandemic lifts.

For a summary by payor as of April 3, 2020, please see below or download our workbook here: COVID-19 Telehealth Guide

Aetna

Category	Telehealth	Telephonic Only
Products Covered	Fully Insured Employer Plans; Individual Plans; Medicare Plans. Self-Insured Groups may opt out of this coverage	Fully Insured Employer Plans; Individual Plans; Medicare Plans. Self-Insured Groups may opt out of this coverage
Required Connection	Audio & Visual	Audio
Effective Date	4-Mar-20	4-Mar-20
Coverage Period	90 days from Effective Date	90 days from Effective Date
Member Cost-Share	Waived	Waived
Billing Guidance	Applicable modifiers "GT" or "95" listed below	Applicable modifiers "GT" or "95" listed below
Exclusions	None listed	None listed
Code Coverage	Updated Code List Below	See code list below

Tricare

Category	Telehealth	Telehealth	Telephonic Only
Products Covered	Tricare	Tricare for Life	No services covered via telephone only.
Required Connection	Audio & Visual	Audio & Visual
Effective Date	Unspecified	Unspecified
Coverage Period	Unspecified	Unspecified
Member Cost-Share	None listed	None listed
Billing Guidance	Standard authorization procedures apply	Standard authorization procedures apply
Exclusions	None listed	None listed
Code Coverage	See listing below	Utilize CMS guidance for telehealth services

Anthem

Category	Telehealth	Telephonic Only	Virtual Care for Therapy Services
Products Covered	Fully Insured Employer Plans; Individual Plans; Medicare Plans. Self-Insured Groups may opt out of this coverage	Fully Insured Employer Plans; Individual Plans; Medicare Plans. Self-Insured Groups may opt out of this coverage	Fully Insured Employer Plans; Individual Plans; Medicare Plans. Self-Insured Groups may opt out of this coverage
Required Connection	Audio & Visual	Audio	Audio & Visual
Effective Date	03/17/2020	03/19/2020	03/17/2020
Coverage Period	90 days from Effective Date	90 days from Effective Date	90 days from Effective Date
Member Cost-Share	Waived	Waived	Waived
Billing Guidance	Submit with the CPT code rendered; Place of Service 02; and append either modifier "95" or "GT"		Submit with the CPT code rendered; Place of Service 02; and append either modifier "95" or "GT"
Exclusions		Chiropractic Services; Physical Therapy; Occupational Therapy; Speech Therapy	Commercial Plans
Code Coverage	Not currently specified by Anthem; recommend reference to CMS guidance	Not currently specified by Anthem; recommend reference to CMS guidance	See list below

Ambetter

Category	Telehealth	Telephonic Only
Products Covered	Commercial Exchange Plans
Required Connection	Audio & Visual	Not currently covered
Effective Date	03/17/2020
Coverage Period	06/30/2020
Member Cost-Share	Follow standard telehealth guidelines; all prior authorization for telehealth will be waived between March 17 and June 30, 2020
Billing Guidance	Follow standard telehealth guidelines; all prior authorization for telehealth will be waived between March 17 and June 30, 2020
Exclusions
Code Coverage	Any services that can be delivered virtually will be eligible for telehealth coverage

Cigna

Category	Telehealth	Telephonic Only	Virtual Care for Therapy Services
Products Covered	Commercial Plans	Commercial Plans	Commercial Plans
Required Connection	Audio & Visual	Audio	Audio & Visual
Effective Date	03/02/2020	03/02/2020	03/02/2020
Coverage Period	Through May 31, 2020	Through May 31, 2020	Through May 31, 2020
Member Cost-Share	Waived for suspected/confirmed COVID-19 cases/Usual cost-shares will apply for all other diagnoses	Waived for suspected/confirmed COVID-19 cases/Usual cost-shares will apply for all other diagnoses	Patient cost-share will apply
Billing Guidance	Bill using a face-to-face E&M code; append the "GQ" modifier and use the POS that would typically be billed for in-office care. (Using POS "02" or modifiers "95/GT" will result in payment reductions based on Cigna's current system; therefore, do not use these).		Bill using designated codes for physical; occupational, and speech therapy codes with a "GQ" modifier and standard POS code.
Exclusions
Code Coverage	See below	See below	Physical Therapy (97161, 97162 & 97110). Occupational Therapy (97165, 97166, 97110). Speech Therapy (92507, 92526)

Humana

Category	Telehealth	Telephonic Only
Products Covered	Commercial Employer-Sponsored Plans & Medicare Plans.	Commercial Employer-Sponsored Plans & Medicare Plans.
Required Connection	Audio & Visual	Audio
Effective Date	03/10/2020	03/10/2020
Coverage Period	90 days from Effective Date	90 days from Effective Date
Member Cost-Share	Waived	Waived
Billing Guidance	Following CMS guidelines	Following CMS guidelines
Exclusions
Code Coverage	See updated code list below. AWV codes are applicable for Medicare only.	See updated code list below.

United Healthcare

Category	Telehealth	Telehealth	Telephonic Only	Electronic Visit
Products Covered	Commercial & Medicare Advantage	Medicare	Commercial & Medicare Advantage	Commercial & Medicare Advantage
Required Connection	Audio & Visual	Audio & Visual	Audio	Online Patient Portal
Effective Date	03/17/2020	03/17/2020
Coverage Period	Through June 18, 2020	Through June 18, 2020
Member Cost-Share	Waived for COVID-19 Only; Cost-Sharing will apply for any other visits	Waived for COVID-19 Only; Cost-Sharing will apply for any other visits
Billing Guidance	CMS Recognized Codes billed with modifier "GT" or "GQ"; all other codes billed will modifier "95"	Billed with modifiers "GT" or "GQ" and POS 02.		For established patients; unrelated to a medical visit within the previous 7 days or resulting in a medical visit within the next 24 hours.
Exclusions	Chiropractor; Physical, Speech & Occupational Therapy Providers	Chiropractor; Physical, Speech & Occupational Therapy Providers
Code Coverage		Recognized by CMS (please reference "Traditional Medicare" tab)	G2010 & G2012	99421-99423 & G2061-G2063

Traditional Medicare

Traditional Medicaid & CMOs

Category	Telehealth
Products Covered	Medicaid
Required Connection	Audio & Visual
Effective Date	03/17/2020
Coverage Period	Not specified
Member Cost-Share	Applicable
Billing Guidance	Utilize a POS telehealth code or a telehealth modifier.
Exclusions	None listed
Code Coverage	Follow guidance from current DCH Telemedicine Platform link

Aetna Codes

Codes Requiring Audio & Visual Connection:
G2061	90957	99212	90785
G2062	90958	99213	G0108
G2063	90960	99214	G0109
H0015 GT or 95	90961	99215	G0296
H0035 GT or 95	90963	99241	G0396
H2012 GT or 95	90964	99242	G0397
H2036 GT or 95	90965	99243	G0406
S9480 GT or 95	90966	99244	G0407
97151 GT or 95	90967	99245	G0408
97155 GT or 95	90968	99231	G0425
97156 GT or 95	90969	99232	G0426
97157 GT or 95	90970	99233	G0427
98970	92227	99251	G0438
98971	93228	99252	G0439
98972	93229	99253	G0442
90951	93268	99254	G0443
99422	93270	99255	G0444
99423	93271	99307	G0445
90791	93272	99308	G0446
90792	96040	99309	G0447
90832	96116	99310	G0459
90833	96160	99354	G0506
90834	96161	99355	G0508
90836	97802	99356	G0509
90837	97803	99357	G0513
90838	G0270	99406	G0514
90839	98960	99407	G2086
90840	98961	G0436	G2087
90845	98962	G0437	G2088
90846	99201	99408
90847	99202	99409
90853	99203	99495
90863	99204	99496
90954	99205	99497
90955	99211	99498
New services
77427; 5 treatments	97112	99223	99336
90953	97116	99224	99337
90959	97151	99225	99341
90962	97153	99226	99342
92507	97155	99231	99343
92521	97156	99232	99345
92522	97157	99233	99347
92953	97161	99234	99348
92954	97162	99235	99349
95121	97163	99236	99350
96130	97164	99238	99421
96131	97165	99239	99422
96132	97166	99281	99423
96133	97167	99282	99468
96136	97168	99283	99469
96137	97535	99284	99471
96138	97755	99285	99472
96139	97760	99291	99475
96158	97761	99292	99476
96159	98970	99304	99477
96164	98971	99305	99478
96165	98972	99306	99479
96166	99217	99315	99480
96167	99218	99316	99483
96168	99219	99327
96170	99220	99238
96171	99221	99334
97110	99222	99335
Codes Requiring Either Audio & Visual Connection or Telephone Only:
G2010	99442	90834 GT or 95	90846 GT or 95
G2012	99443	90836 GT or 95	90847 GT or 95
98966	90791 GT or 95	90837 GT or 95	90853 GT or 95
98967	90792 GT or 95	90838 GT or 95	90863 GT or 95
98968	90832 GT or 95	90839 GT or 95	96116 GT or 95
99441	90833 GT or 95	90840 GT or 95

Tricare Codes

Codes Requiring Audio & Visual Connection:
Office Visits	Preventive Health Screenings	Telemental Health Services
ESRD Services	Applied Behavioral Therapy under Autism CARES Act

Anthem Codes

Codes Requiring Audio & Visual Connection:
Reference CMS guidelines; currently undefined by Anthem	Codes Requiring Telephonic Connection:	Reference CMS guidelines; currently undefined by Anthem	Therapy Services Virtual Care
Physical Therapy
97161	97162	97163	97164
Occupational Therapy
97165	97166	97167	97168
PT/OT Treatment
97110	97112	97530	97535
Speech Therapy Evaluation
92521	92522	92523	92524
Speech Therapy Treatment
92507	92526	92606	92609

Cigna Codes

Telehealth	Telephonic Only
99201-99215	G2012

Humana Codes

Codes Requiring Audio & Visual Connection:
90785	97803	99341	G0108
90791	97804	99342	G)109
90792	99201	99343	G0270
90832	99202	99344	G0296
90833	99203	99345	G0396
90834	99204	99347	G0397
90836	99205	99348	G0406
90837	99211	99349	G0407
90838	99212	99350	G0408
90839	99213	99354	G0420
90840	99214	99355	G0421
90846	99215	99358	G0425
90847	99217	99359	G0426
92227	99238	99387	G0427
92228	99239	99397	G0436
93228	99304	99406	G0437
93229	99305	99407	G0438
93268	99306	99415	G0439
93270	99307	99416	G0442
93271	99308	99421	G0443
93272	99309	99422	G0444
96116	99310	99423	G0459
96127	99315	99441	G0506
96157	99316	99442	G2011
96158	99318	99443	G2086
96159	99324	99446	G2087
96160	99325	99447	G2088
96161	99326	99448
96164	99328	99449
96165	99334	99495
96167	99335	99496
96168	99336	99497
97802	99337	99498

Codes Using Telephone Only:
G2012	99421	99423	G2063
G2010	99422	G2062

United Healthcare Codes

Codes Requiring Audio & Visual Connection & Modifiers "GT" or "GQ":
90785	96151	99495	G0513
90791	96152	99496	G0514
90792	96153	99497	G2086
90832	96154	99498	G2087
90833	96160	G0108	G2088
90834	96161	G0109	G9481
90836	97802	G0270	G9482
90837	97803	G0296	G9483
90838	97804	G0396	G9484
90839	99201	G0397	G9485
90840	99202	G0406	G9486
90845	99203	G0407	G9487
90846	99204	G0408	G9488
90847	99205	G0420	G9489
90951	99211	G0421	G9978
90952	99212	G0425	G9979
90954	99213	G0426	G9980
90955	99214	G0427	G9981
90957	99215	G0436	G9982
90958	99231	G0437	G9983
90960	99232	G0438	G9984
90961	99233	G0439	G9985
90963	99307	G0442	G9986
90964	99308	G0443
90965	99309	G0444
90966	99310	G0445
90967	99354	G0446
90968	99355	G0447
90969	99356	G0459
90970	99357	G0506
96116	99406	G0508
96150	99407	G0509

Codes Requiring Audio & Visual Connection & Modifiers "95":
90785	90955	97803	99307
90791	90957	97804	99308
90792	90958	98960	99309
90832	90960	98961	99310
90833	90961	98962	99354
90834	92227	99201	99355
90836	92228	99202	99406
90837	93228	99203	99407
90838	93229	99204	99408
90839	93268	99205	99409
90840	93270	99212	99495
90845	93271	99213	99496
90846	93272	99214
90847	93298	99215
90951	96040	99231
90952	96116	99232
90954	97802	99233

Medicare Codes

Codes Requiring Audio & Visual Connection:
90785	90968	99307	G0427
90791	90969	99308	G0436
90792	90970	99309	G0437
90832	96116	99310	G0438
90833	96150	99354	G0439
90834	96151	99355	G0442
90836	96152	99356	G0443
90837	96153	99357	G0444
90838	96154	99406	G0445
90839	96160	99407	G0446
90840	96161	99495	G0447
90845	97802	99496	G0459
90846	97803	99497	G0506
90847	97804	99498	G0508
90951	99201	G0108	G0509
90952	99202	G0109	G0513
90954	99203	G0270	G0514
90955	99204	G0296	G2086
90957	99205	G0396	G2087
90958	99211	G0397	G2088
90960	99212	G0406
90961	99213	G0407
90963	99214	G0408
90964	99215	G0420
90965	99231	G0421
90966	99232	G0425
90967	99233	G0426

Codes Requiring Telephone/Patient Portal Only:
G2012	99431	99423	G2063
G2010	99422	G2062