CAM 176

Telehealth

Category:Medicine   Last Reviewed:October 2021
Department(s):Medical Affairs   Next Review:October 2022
Original Date:October 2017    

Description
Telehealth is a potentially useful tool that, if employed appropriately, can provide important benefits to patients, including: increased access to health care, expanded utilization of specialty expertise, rapid availability of patient records, and the reduced cost of patient care.

Definition of services:
Telehealth is the interaction of patient and clinician via electronic communications to improve a patient’s clinical health status. Telehealth includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications. It is frequently initiated by the patient through a secure, encrypted interchange.

Policy 
Telehealth services are considered MEDICALLY NECESSARY if they meet the guidelines below. 

Policy Guidelines 
Services using secure telehealth technologies between a provider in one location and a patient in another location may be reimbursed when all of the following conditions are met:

  • The patient is present at the time of service;
  • All services provided are medically appropriate and necessary; 
  • The encounter satisfies the elements of the patient-provider relationship, as determined by the relevant healthcare regulatory board of the state where the patient is physically located;
  • The service takes place via an interactive audio and video telecommunications system. Interactive telecommunications systems must be multi-media communication that, at a minimum, includes audio and video equipment permitting real-time consultation among the patient, consulting practitioner, and referring practitioner (as appropriate);
  • The service is conducted over a secured channel with provisions described in Policy Guidelines;
  • A permanent record of online communications relevant to the ongoing medical care and follow-up of the patient is maintained as part of the patient’s medical record;
  • The extent of any evaluation and management services (E/M) provided over the Telehealth technology includes at least a problem focused history and straight forward medical decision making, as defined by the current version of the Current Procedural Terminology (CPT) manual.
  • The provider is approved to perform telehealth services.

Telehealth services are not reimbursed for the following:

  • Telehealth that occurs the same day as a face to face visit, when performed by the same provider and for the same condition.
  • Services performed via asynchronous communications systems.
  • Services performed via telephonic (audio only) consultations. (See Section “Benefits Application” regarding availability of member benefits for telephonic services.) that originates from a related E/M service provided within the previous 7 days or leads to an E/M service or procedure within 24 hours.
  • Triage to assess the appropriate place of service and/or appropriate provider type.
  • Patient communications incidental to E/M, counseling, or medical services covered by this policy, including, but not limited to:
    • Reporting of test results that are not deemed abnormal and require a face to face visit,
    • Provision of educational materials.
  • Administrative matters, including but not limited to, scheduling, registration, updating billing information, reminders, requests for medication refills or referrals, ordering of diagnostic studies, and medical history intake completed by the patient.

Approved Clinicians who may bill for a covered telehealth services are listed below:

  • Physician
  • Nurse practitioner
  • Physician assistant
  • Clinical nurse specialist
  • Clinical psychologist
  • Clinical social worker
  • Licensed professional counselor
  • Licensed marriage and family therapist
  • Physical therapist
  • Occupational therapist
  • Speech therapist

Telehealth is an effective means of providing health care to patients with accessibility problems, including living in isolated communities, physical disabilities or chronic illnesses. Telehealth has become increasingly important in the healthcare community and general population.

Security and Confidentiality
Providers who utilize telehealth systems must consider security, patient confidentiality, and privacy. A secured electronic channel is required to be utilized by a telehealth provider. The electronic channel must be secured, encrypted, and include and support all of the following:

  • A mechanism to authenticate the identity of correspondent(s) in electronic communication and to ensure that recipients of information are authorized to receive it.
  • The patient’s informed consent to participate in the consultation, including appropriate expectations, disclaimers and service terms, and any fees that may be imposed. Expectations for appropriate use must be specified as part of the consent process including: use of specific written guidelines and protocols, avoiding emergency use, heightened consideration of use for highly sensitive medical topics, relevant privacy issues.
  • An established turnaround time for responses from the provider. The system should alert the physician or practice that there is an outstanding request for an e-visit.
  • Structured symptom assessment and risk reduction features. (i.e., patients are directed to contact the practice and/or emergency room if certain symptoms are reported).
  • An electronic communication system that generates an automatic reply to acknowledge receipt of messages or indicates that the provider is unable to respond.
  • The name and patient identification number.
  • A standard block of text contained in the provider’s response that displays the physician’s full name, contact information and reminders about security and the importance of alternative forms of communication for emergencies.
  • No inclusion of third party advertising and the patient’s information is not to be used for marketing.
  • Payment Card Industry Data Security Standard (PCI-DSS) compliant.
  • A fully executed Business Associate Agreement (BAA) with the telehealth vendor, system or platform.

Protocols for the Telehealth Visit

  • Dress appropriately for the virtual visit. We recommend the same level of professional attire as in your practice. This is especially true if you are conducting the visit from the privacy of your home office. The telehealth visit should duplicate the same level of professionalism found in your physician office address.
  • For recommendations on lighting & cameras, walls & backdrops, etc. please review the document published by the American Telemedicine Association, “Let There Be Light: A Quick Guide to Telemedicine Lighting”  (http://higherlogicdownload.s3.amazonaws.com/AMERICANTELEMED/618da447-dee1-4ee1-b941-c5bf3db5669a/UploadedImages/NEW%20Practice%20Guidelines/Let_There_Be_Light_Quick_Guide.pdf) 

Termination of expanded telehealth services related to the COVID-19 pandemic:

Effective 05/01/2021 the following services will no longer be allowed as telehealth services: 98966-98968, 92521,92526, 92610, 97110, 97112, 97162, 97163, 97166, 97167, 97530, 99217-99226, 99231-99236, 99238-99239, 99281-99285, 99291-99292, 99382-99387, 99392-99397, 99341-99350, G0151-G0155, G0159-G0162,S9127-S9131, G0299, G0300, Q5001, S9123, S9124, T1030, T1031, 99495 and 99496

TEMPORARY EXPANSION OF REIMBURSEMENT FOR TELEHEALTH SERVICES:

In response to the recent coronavirus (COVID-19) outbreak, Blue Cross Blue Shield of South Carolina is expanding reimbursement for all services delivered through telehealth that meet the coverage criteria in the policy.  The expansion supports the diagnosis and treatment of COVID-19 as well as minimizes unnecessary exposure to individuals needing medical care for other conditions.  Reimbursement for the expanded set of services delivered through telehealth will be in place for thirty (30) days starting March 16, 2020 and then be reevaluated for possible extension. 

Effective 04/09/2020 the expansion of telehealth services has been extended to 05/16/2020 with reevaluation for possible extension on or before 05/16/2020.

Effective 05/12/2020 the expansion of telehealth services has been extended to 06/15/2020 with reevaluation for possible extension on or before 06/15/2020.

Effective 06/10/2020 the expansion of telehealth services has been extended to 08/01/2020 with reevaluation for possible extension on or before 08/01/2020.

Effective 07/16/2020 the expansion of telehealth services has been extended to 10/01/2020 with the following change effective 08/01/2020 no longer pay for telehealth delivered via non-HIPAA compliant technologies. 

Effective 09/08/2020 the expansion of telehealth services has been extended to 12/31/2020, telehealth delivered via non-HIPAA compliant technologies will remain non covered.

Effective 01/01/2021 the expansion of telehealth services will continue to be allowed until further notice. Ongoing coverage will be continually assessed during the COVID-19 pandemic.  Telehealth delivered via non-HIPAA-compliant technologies will remain noncovered.

In some settings, video capability may not be available, or the member may ask to discontinue the video.  Telehealth consultations during this temporary expansion may be performed telephonically. This includes temporary coverage of the following telephonic evaluation and management services:  

98966: TELEPHONE ASSESSMENT AND MANAGEMENT SERVICE PROVIDED BY A QUALIFIED NONPHYSICIAN HEALTH CARE PROFESSIONAL TO AN ESTABLISHED PATIENT, PARENT, OR GUARDIAN NOT ORIGINATING FROM A RELATED ASSESSMENT AND MANAGEMENT SERVICE PROVIDED WITHIN THE PREVIOUS 7 DAYS NOR LEADING TO AN ASSESSMENT AND MANAGEMENT SERVICE OR PROCEDURE WITHIN THE NEXT 24 HOURS OR SOONEST AVAILABLE APPOINTMENT; 5-10 MINUTES OF MEDICAL DISCUSSION

98967: TELEPHONE ASSESSMENT AND MANAGEMENT SERVICE PROVIDED BY A QUALIFIED NONPHYSICIAN HEALTH CARE PROFESSIONAL TO AN ESTABLISHED PATIENT, PARENT, OR GUARDIAN NOT ORIGINATING FROM A RELATED ASSESSMENT AND MANAGEMENT SERVICE PROVIDED WITHIN THE PREVIOUS 7 DAYS NOR LEADING TO AN ASSESSMENT AND MANAGEMENT SERVICE OR PROCEDURE WITHIN THE NEXT 24 HOURS OR SOONEST AVAILABLE APPOINTMENT; 11-20 MINUTES OFMEDICAL DISCUSSION

98968: TELEPHONE ASSESSMENT AND MANAGEMENT SERVICE PROVIDED BY A QUALIFIED NONPHYSICIAN HEALTH CARE PROFESSIONAL TO AN ESTABLISHED PATIENT, PARENT, OR GUARDIAN NOT ORIGINATING FROM A RELATED ASSESSMENT AND MANAGEMENT SERVICE PROVIDED WITHIN THE PREVIOUS 7 DAYS NOR LEADING TO AN ASSESSMENT AND MANAGEMENT SERVICE OR PROCEDURE WITHIN THE NEXT 24 HOURS OR SOONEST AVAILABLE APPOINTMENT; 21-30 MINUTES OF MEDICAL DISCUSSION 

Medical record documentation may be requested and audited to confirm the medical appropriateness of these telephone-based services.  

Effective immediately (03/19/2020) evaluation and management services reflected by the following codesets 99201-99203 and 99211-99215  with modifier 95 appended. Providers will need to continue to use the previously established application process for this to apply to their practices. This does NOT apply to telephone based visits which are reflected in the codeset 99441-99443.

In conjunction with the temporary expansion detailed above, speech, physical and occupational therapy visits may be filed with the above criteria and modifier -95. The following codes may be filed to reflect the services provided: 92507, 92521-92526, 92610, 97110, 97112, 97129, 97130, 97161-97168 and 97530. Providers will also need to also submit an application for telehealth coverage.

In conjunction with the above expanded services, effective 03/19/2020, CPT code services reflected by 90853 will be added to telehealth coverage.

Additional expansion of telehealth services include the following codesets observation care, Inpatient hospital care (99217-99226, 99231-99236, 99238-99239), emergency department care (99281-99285), and Critical Care (99291-99292) with modifier 95 appended . Providers will need to continue to use the previously established application process for this to apply to their practices. This does NOT apply to telephone based visits which are reflected in the codeset 99441-99443. 

Effective 04/16/2020 telehealth services will be expanded to allow for preventive medicine services. Codes 99382-99387 or 99392-99397 filed with modifier 95 must be utilized to represent these services.   Providers will need to use the previously established telehealth application process for this to apply to their practices.  This does not apply to telephone based services which are reflected in the code set  99441-99443. It is expected that the usual other objective components of a well visit (weight, height, vital signs, physical exam and in-office testing and screening) be completed within 60 days of the pandemic end with no submission of additional E&M codes to BCSBSC. The office records from the completion of the telehealth service must contain the date of the telehealth visit for auditing purposes.  Additionally, vaccines and immunizations related to these telehealth visits should be administered and filed with no change to coding or associated reimbursement for those services also within 60 days of the termination of the pandemic. Audit of these visits and follow-up care will be done at the discretion of the plan. 

Effective immediately 04/16/2020, a temporary expansion of home health services and hospice services  will allow these services to be provided via telehealth when filed with a 95 modifier subject to the member’s benefits and limitations during the COVID-19 pandemic :  99341-99350, G0151-G0155, G0159-G0162, S9127-S9131, G0299, G0300,Q5001, S9123, S9124, T1030, T1031, 92507, 92521-92526, 97110, 97112, 97129, 97130, 97161-97168 and 97530.  Provider will also need to submit an application for telehealth coverage. 

Effective 07/10/2020, transitional care management services reflected with codes 99495 and 99496 will be included in the expansion of telehealth services related to the COVID-19 outbreak.

The above temporary modifications apply to all licensed and credentialed providers in their scope of practice.  While these temporary modifications are in place, there will be a waiver of the portion of the CPT verbiage that relates to visits provided within 7 days.  Two telephonic services may occur within 7 days during the temporary modification period.

References 

  1. 1997 North Carolina Senate Bill 780
  2. Medical Policy Advisory Group - 12/99
  3. Medical Policy Advisory Group - 3/1/2001
  4. Specialty Matched Consultant Advisory Panel - 9/2002
  5. Medical Policy Advisory Group - 10/2003
  6. Medical Policy Advisory Group - 9/2005
  7. Agency for Healthcare Research and Quality (AHRQ). Telemedicine for the Medicare Population: Update. Evidence Report/Technology Assessment Number 131. Rockville, MD: AHRQ; February 2006. Use update from AHRQ http://www.innovations.ahrq.gov/content.aspx?id=2847
  8. Specialty Matched Consultant Advisory Panel- 2/2012
  9. Centers for Medicare and Medicaid Services. Available online at http://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/
  10. Centers for Medicare and Medicaid Services. Telehealth Services. Available online at www.cms.gov/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf . Last accessed February 2013.
  11. North Carolina General Assembly. Telemedicine. Available online at: www.ncga.state.nc.us. Last accessed February 2013.
  12. North Carolina General Assembly. http://www.ncleg.net/Sessions/2009/Bills/House/PDF/H1189v3.pdf
  13. Dixon BE, Hook JM, McGowan JJ. Using Telehealth to Improve Quality and Safety: Findings from the AHRQ Portfolio (Prepared by the AHRQ National Resource Center for Health IT under Contract No. 290-04-0016). AHRQ Publication No. 09-0012-EF. Rockville, MD: Agency for Healthcare Research and Quality. December 2008.Available at http://healthit.ahrq.gov/images/dec08telehealthreport/telehealth_issue_paper.htm. Last accessed February 2013.
  14. Specialty Matched Consultant Advisory Panel- 2/2013
  15. American Medical Association Policy H-160.937 The Promotion of Quality Telemedicine. https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fhtml%2fPolicyFinder%2fpolicyfiles%2fHnE%2fH-160.937.HTM
  16. North Carolina Medical Board (NCMB). Position Statement: Telemedicine. 11/2014. http://www.ncmedboard.org/position_statements/detail/telemedicine
  17. North Carolina Medical Board (NCMB). Position Statement: The physician-patient relationship. 7/2012. http://www.ncmedboard.org/position_statements/detail/the_physician-patient_relationship
  18. http://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/Downloads/IDEATel_FirstReport.pdf
  19. AMA Guidelines for Physician-Patient Electronic Communications. http://www.ama-assn.org/ama/pub/catergory/print/2386.html
  20. The AMA Code of Medical Ethics Opinion 5.026: The Use of Electronic Mail. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion5026.page
  21. Council on Ethical and Judicial Affairs Report 3-1-02: Ethical Guidelines for the Use of Electronic Mail between Patients and Physicians, adopted December 2002. http://ppmedmn.com/AMA%20Council%20on%20Ethical%20and%20Judicial%20Affairs%20-%20June%20%2703.doc.pdf
  22. H-478.997 Guidelines for Patient-Physician Electronic Mail http://hosted.ap.org/specials/interactives/_documents/patient_physician_email.pdf
  23. General assembly of North Carolina. Session 2013. Senate bill 533. Study Telemedicine & Health Home Initiatives.
  24. http://www.ncleg.net/Sessions/2013/Bills/Senate/PDF/S533v1.pdf
  25. American Telemedicine Association. What is Telemedicine?
  26. http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.VIrub_ldUVc
  27. North Carolina Board of Pharmacy (NCBOP). Rules, Statutes, Board Policies. 1/2015.
  28. http://www.ncbop.org/LawsRules/Rules.pdf
  29. Medical Director review 12/2014
  30. Centers for Medicare & Medicaid Services (CMS). Claims Processing Manual 2015 for Telemedicine (190-190.5). http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
  31. American Medical Association (AMA). Chicago. Current Procedural Terminology (CPT) 2015.
  32. Medical Director review 7/2015 

Coding Section 

Code Number Description
 CPT 90791-90792  Psychiatric diagnostic evaluation services
  90832-90838  Psychotherapy services 
  90845  Psychoanalysis 
  90846  Family psychotherapy (without the patient present), 50 minutes 
  90847  Family psychotherapy (conjoint psychotherapy) (with paitent present), 50 minutes
  90853  Group psychotherapy (other than of a multiple-family group)  
  92507  Treatment of speech, language, voice, communication, and/or auditory processing disorder 
  92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) 
  92523  Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) 
  92524  Behavioral and qualitative analysis of voice and resonance 
  96040, S0265  Genetic counseling 
  95251  Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report.
  96116  Neurobehavioral status exam 
  96156 Health behavior assessment or reassessment
  96158

Health and behavior intervention, initial 30 minutes; individual

  96159

Health and behavior intervention, each 15 minutes; individual

  96164

Health and behavior intervention, initial 30 minutes; group

  96165 Health and behavior intervention, each 15 minutes; group
  96167 Health and behavior intervention, initial 30 minutes; family plus patient
  96168 Health and behavior intervention, each 15 minutes; family plus patient
  96170 Health and behavior intervention, initial 30 minutes; family without patient
  96171 Health and behavior intervention, each 15 minutes; family without patient
  97129  Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes. 
  97130  each additional 15 minutes (list separately in addition to code for primary procedure) 
  97161  Physical therapy evaluation: low complexity, requiring these components: • A history with no personal factors and/or comorbidities that impact the plan of care; • An examination of body system(s) using standardized tests and measures addressing 1-2 elements. 
  97164  Re-evaluation of physical therapy established plan of care, requiring these components:  An examination including a review of history and use of standardized tests and measures is required; and a revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family. 
  97165 

Occupational therapy evaluation, low complexity, requiring these components:

  • An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem;
  • An assessment[s] that identifies 1—3 performance deficits [ie, relating to physical, cognitive, or psychosocial skills] that result in activity limitations and/or participation restrictions; and
  • Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment[s], and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance [eg, physical or verbal] with assessment[s] is not necessary to enable completion of evaluation component.

Typically, 30 minutes are spent face to face with the patient and/or family. 

  97168 

Re-evaluation of occupational therapy established plan of care, requiring these components:

  • An assessment of changes in patient functional or medical status with revised plan of care;
  • An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and
  • A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required.

Typically, 30 minutes are spent face to face with the patient and/or family. 

  99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family. Billing Instructions: Bill 1 unit per visit.
  99203  Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. Billing Instructions: Bill 1 unit per visit. 
  99211-99215  Established outpatient evaluation and management 
  99402  Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes 
  99404  Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes 
  99406  Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 
  99407  Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes 
  99408  Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 min 
  99409  Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 min 
  99497  Advance care planning by the physician or other qualified health care professional, first 30 minutes, face-to-face; patient, family and/or surrogate 
  99498  Advance care planning by the physician or other qualified health care professional, first each additional 30 minutes, face-to-face; patient, family and/or surrogate 
  G0108-G0109  Diabetic training 
Modifiers  95  Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each Policy. They may not be all-inclusive. 

Disclaimer:  Please refer to contract requirements as this policy does not guarantee payment of telehealth services.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies, and accredited national guidelines.

"Current Procedural Terminology © American Medical Association. All Rights Reserved" 

History From 2017 Forward     

10/08/2021 

Annual review, no change to policy intent. 

08/19/2021 

Adding dashes to date on external policy. No other changes made. 

04/23/2021 

Correcting error in coding. 

04/19/2021

Correct typo in history section dated 3/23/2021 9387 should be 99387 . No other changes made. 

03/29/2021 

Updating to add speech therapists to the list of provider specialty types who can perform some telehealth services. No other changes.

03/25/2021 

Interim review, adding 90853 as eligible for telehealth services and adding physical and occupational therapists as clinicians who can provide the approved telehealth services. 

03/24/2021 

Interim review to add termination date for expanded services during the COVID-19 pandemic. Updating the following codes as being added to allow via telehealth: 99202-99203, 99214-99215, 92507, 92522-92524, 97129-97130, 97161, 97164, 97165 and 97168. No other changes made. 

03/23/2021 

Interim review to add temporary telehealth coverage for 99386, 99387, 99396 and 99397 with a retroactive date of 04/16/2020. No other changes made. 

02/24/2021 

Interim review to update coding section to include 90846, 90845-90847. No other changes. 

12/17/2020 

Interim review to provide expanded telehealth coverage for 90853. No other changes. 

12/11/2020 

Effective 01012021 the expansion of telehealth services will continue to be allowed until further notice. Ongoing coverage will be continually assessed during the COVID pandemic. Telehealth delivered via non-HIPAA compliant technologies will remain non covered. 

10/23/2020 

Added code '95251'   

10/06/2020 

Adding A fully executed Business Associate Agreement (BAA) with the telehealth vendor, system or platform to the security and confidentiality section. No other changes. 

09/21/2020 

Updating coding. Removed code set 99241-99243. No other changes made. 

09/08/2020 

Interim review extending expanded telehealth services related to COVID 19 until 12312020. No other changes made. 

07/14/2020 

Interim review extended telehealth services related to the COVID 19 pandemic to 10012020 with notation that effective 08012020 no longer pay for telehealth delivered via non-HIPAA compliant technologies. 

07/10/2020 

Interim review to expand telehealth coverage to encompass 99495/99496 effective 07102020. No other changes made. 

06/15/2020 

Interim review: returning telehealth coverage to observation care, inpatient hospital care (99217-99226, 99231-99236, 99238-99239), emergency department care (99281-99285), and critical care (99291-99292), with modifier 95 appended. 

06/10/2020 

Interim review to extend the date of expanded services coverage related to COVID 19 to 08012020 with the exception of: Additional expansion of telehealth services include the following codesets observation care, Inpatient hospital care (99217-99226, 99231-99236, 99238-99239), emergency department care (99281-99285), and Critical Care (99291-99292) with modifier 95 appended . Providers will need to continue to use the previously established application process for this to apply to their practices. This does NOT apply to telephone based visits which are reflected in the codeset 99441-99443. This subset of codes will no longer apply to the expanded telehealth coverage effective 06152020. No other changes made. 

05/12/2020 

Interim review, extending timeframe for expanded services related to COVID-19 to 06152020. 

04/28/2020 

Updating temporary expansion services to include 92610 in the speech therapy section. 

04/21/2020 

Interim review to remove U9 modifier requirement for preventive pediatric visit telehealth expansion for the pandemic and replaced it with a requirement to file modifier 95 with those services. 

04/16/2020 

Interim review to add expanded telehealth coverage during the COVID-19 pandemic that states: Effective immediately 04162020 a temporary expansion of home health services and hospice services will allow these services to be provided via telehealth when filed with a 95 modifier subject to the member’s benefits and limitations during the COVID-19 pandemic : 99341-99350, G0151-G0155, G0159-G0162, S9127-S9131, G0299, G0300,Q5001, S9123, S9124, T1030, T1031, 92507, 92521-92526, 97110, 97112, 97129, 97130, 97161-97168 and 97530. Provider will also need to submit an application for telehealth coverage. 

04/16/2020 

Interim review to add expanded telehealth coverage for pediatric preventive medicine services during the pandemic. 

04/14/2020 

Interim review to add expanded coverage during the COVID-19 pandemic for: Additional expansion of telehealth services include the following codesets observation care, Inpatient hospital care (99217-99226, 99231-99236, 99238-99239), emergency department care (99281-99285), and Critical Care (99291-99292) with modifier 95 appended may be utilized for HIPAA-compliant telehealth systems in which care is delivered synchronously using both audio and visual modalities. Providers will need to continue to use the previously established application process for this to apply to their practices. This does NOT apply to telephone based visits which are reflected in the codeset 99441-99443 

04/09/2020 

Extending telehealth coverage during pandemic to 05162020. Will re-evaluate further extensions. 

04/01/2020 

Interim review related to expanded services during the COVID-19 pandemic to add codes 97168, 97110, 97112 and 97530. 

03/31/2020

Updating temporary criteria to provide specific verbiage related to PT/OT/ST. 

03/26/2020 

Adding 98966-98968 to the temporary expansion of services portion of the policy. 

03/24/2020 

Updating verbiage in the section of the policy related to temporary expansion of reimbursement for telehealth services to include:The above temporary modifications apply to all licensed and credentialed providers in their scope of practice. While these temporary modifications are in place, there will be a waiver of the portion of the CPT verbiage that relates to visits provided within 7 days. Two telephonic services may occur within 7 days during the temporary modification period. 

3/19/2020 

Updating verbiage related to coding for temporarily allowed telephonic E&M's. 

03/16/2020 

Interim review to add temporary services related to COVID-19. 

10/01/2019 

Annual review, updating to add protocols for telehealth visits, updated coding and clarified services available for telehealth. 

04/24/2019 

Interim review to add licensed professional counselor and licensed marriage and family therapist as specialty types approved to file for telehealth services. No other changes made. 

03/28/2019 

Interim Review. Updated Policy guidelines  and definition of services and updated coding. 

10/18/2018 

Annual review of policy, multiple revisions to description and policy for clarity, intent of policy unchanged.  Removing  modifier  GT  from  coding  section.

01/08/2017 

Formatting policy.

10/30/2017

New Policy


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