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04/03/2020 – Medicare Coverage and Payment of Virtual Services – CMSVideo
TELEMEDICINE AND VIRTUAL VISITS
There are continuous updates being added to NaviNet; please check frequently. See below screen shots as to where to find this information and links for the Covid-19 information.
- Highmark is strongly encouraging members take advantage of Virtual Visits for Behavioral Health, PCP, Retail Clinic and Teledermatology during the COVID-19 Pandemic.
- Cost sharing will be waived for Virtual Visits for a 90-day period, 03/13/20 – 06/13/20. This applies to select commercial accounts.
- Virtual Behavioral Health, Virtual PCP Visits and Virtual Retail Clinic Visits will be available using secure telecommunications technology to provide services remotely. Any telecommunication technology used needs to provide both audio and video streams. (Phone calls are not eligible as Virtual Visits).
- Telemedicine is defined as the exchange of medical information between sites via electronic communication for transmitting clinical information for diagnostic, monitoring, and therapeutic purposes
- Direct link into NaviNet for COVID-19 https://hbcbsnn.highmarkprc.com/Newsletters-Notices/COVID-19CORONAVIRUS-INFORMATION-FOR-Providers
- COVID-19 information for members and providers: ttps://faqs.discoverhighmark.com
Virtual PCP and Retail Clinic Visits
When billing professional services (1500/837P), Virtual PCP Visits and Virtual Retail Clinic Visits should be billed with Evaluation & Management (E&M) CPT codes (99201-99205; 99211-99215) applicable to the services provided and with the GT or 95 modifier indicating the use of interactive audio and video telecommunications technology.
Outpatient facility claims (UB-04/8371) should be billed using the appropriate procedure code (99201 – 99205: 99211-99215 or G0463) with the GT or 95 modifiers and the revenue code 780.
Note: Place of Service ·02· (Telehealth) must be used when reporting professional teleheallh services (1500 form). OP Facility claims must also use the GT and 95 modifiers as appropriate and applicable.
Virtual visit services the Plan does not reimburse include. but are not limited to, the following:
- Mental health counseling and therapy’ (See virtual behavioral health section for eligible virtual mental health services)
- Asynchronous (online) medical evaluation (e-Visils) or treatment.
- Remote critical care services (0188T, 0189T)
- Unsecured and unstructured services such as, but not limited to, skype and instant messaging
- Clinician-lo-clinician consultations, telephone conversations, facsimile, or email communications
‘ Note: Coverage for mental and behavioral health virtual visits is defined by the member’s benefit plan.
To help avoid further spread the virus, Highmark is actively encouraging our members to utilize telemedicine services and virtual visits as available based on their benefits.
We’re waiving all telemedicine and virtual visit appointment fees for the next 90 days for all Medicare Advantage, ACA, and select employer plans.
Highmark members are able to access information regarding their benefits by calling Highmark Member Service at the number displayed on the back of their member identification card.
Am I able to provide care via telemedicine?
Highmark provides telemedicine coverage options through national telemedicine vendors as well as our in-network primary care and specialist providers who choose to offer such services using appropriate telecommunications technology.
If you do not already offer these services, but are interested in providing them to your patients, you must 1) be a US-based, board certified and licensed to practice medicine in the state in which the member is located, and 2) use technology that is private, secure and HIPAA-compliant in order to provide a safe and confidential consult with a doctor online.
For the rest of the health guidelines, Highmark Provider Manual Chapter 2 Unit 5: Telemedicine Services.
What if I do not want or cannot provider telemedicine services or virtual visits?
Members may use American Well™ (Amwell). Through discussions with them, we anticipate that there is more than adequate capacity to support our members as demand for such services increases. As we continue to monitor the COVID-19 crisis, we will routinely assess service demands with our telemedicine vendor partners.
• UPMC Health Plan’s technical requirements and information on all covered telehealth services can be found in UPMC Heath Plan policy MP.148, which is available online through our Policies and Procedures Manual at upmchp.us/policiesandprocedures.
• UPMC Health Plan covers a brief (5-10 min) remote interaction, typically via telephone between a provider and their existing patient. This visit cannot be related to an Evaluation and Management (E/M) visit within the previous seven days or result in an E/M visit or appointment in the next 24 hours. This service is known as a “Virtual Check-In” and can be billed using code G2012.
• Providers should bill their current Place of Service as 02 for telehealth visits.
• Behavioral health telehealth visits are covered as indicated in UPMC Health Plan Telehealth policy MP.148.
• Effective immediately until June 15, patients can get medical attention quickly and safely at $0 copay for all covered telehealth services. UPMC Health Plan will waive any deductibles,‡ copayments, or other cost-sharing for all in-network telehealth visits, including UPMC AnywhereCare. Patients who are not UPMC Health Plan members can still access UPMC AnywhereCare; they will be charged $59 for the visit.
• As previously communicated, effective immediately until June 15, UPMC Health Plan will cover COVID-19 diagnostic laboratory testing at no-cost as a preventive service for UPMC Health Plan members.
• As previously communicated, no member cost-share will apply to TESTING procedures only for all UPMC Health Plan products and providers if billed under CPT Code 87635 OR HCPCS Code U0002. These procedures do not require prior authorization.
• UPMC Health Plan is committed to complying with CMS and state requirements for telehealth services. Please check our websites listed below for daily updates.
Please keep up to date on the most recent information by visiting and consistently checking back for updates:
• UPMC Health Plan provider announcements: upmchp.us/announcement-updates
• UPMC Health Plan coronavirus website: www.upmchealthplan.com/covid-19
• UPMC Health Plan Policies and Procedures Manual: upmchp.us/policiesandprocedures
• CDC Website: upmchp.us/cdc-covid-19
Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit
Under President Trump’s leadership to respond to the need to limit the spread of community COVID-19, the Centers for Medicare & M edicaid Services (CMS) has broadened access to Medicare telehealth
services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. These policy changes build on the regulatory flexibilities granted under the
President’s emergency declaration. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. The benefits are part of the broader effort by CMS and the White House Task Force
to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19, are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus.
Effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.
These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
Starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas of the country in all settings.
While they must generally travel to or be located in certain types of originating sites such as a physician’s office, skilled nursing facility or hospital for the visit, effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.
The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.
COVID-19 Telehealth Services
Effective immediately, UnitedHealthcare is expanding our policies around telehealth services for our Medicare Advantage, Medicaid and commercial membership, making it even easier for patients to connect with their health care provider.
Expanded Provider Telehealth Access
Through June 18, 2020, eligible medical care providers who have the ability and want to connect with their patient through synchronous virtual care (live video-conferencing) can do so. Benefits will be processed in accordance with the member’s plan.
UnitedHealthcare will waive the Centers for Medicare and Medicaid’s (CMS) originating site restriction for Medicare Advantage, Medicaid and commercial members, so that eligible care providers can bill for telehealth services performed while a patient is at home.
This policy change applies to members whose benefit plans cover telehealth services, and will allow those patients to connect with their doctor through audio/video visits. Member cost sharing will be waived for COVID-19 testing-related visits during this national emergency.
UnitedHealthcare will also reimburse care providers for telephone calls to existing patients, as described within each of the sections below.
HHS Office of Civil Rights Enforcement Discretion related to HIPAA
In light of the COVID-19 nationwide public health emergency, the HHS Office for Civil Rights (OCR) is exercising its enforcement discretion and, effective immediately, will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA).
Physicians may seek to communicate with patients and provide telehealth services through remote communications technologies. Some of these technologies, and their use, may not fully comply with the requirements of the HIPAA Rules.
However, today’s announcement means that physicians who want to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing service that is available to communicate with patients. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.
For example, a physician using their professional judgement may request to examine a patient exhibiting COVID-19 symptoms, using a video chat application connecting the physician’s or patient’s phone or desktop computer in order to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation. Likewise, a physician may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to COVID-19, such as a sprained ankle, dental consultation or psychological evaluation, or other conditions.
Under this Notice, physicians may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules. Physicians should not use Facebook Live, Twitch, TikTok or other public facing communication services. Physicians are encouraged, but not required, to notify patients of the potential security risks of using these services and to seek additional privacy protections by entering into HIPAA business associate agreements (BAA). HHS also noted that while it hasn’t confirmed such statements, Skype for Business, Updox, VSee, Zoom for Healthcare, Doxy.me, and Google G Suite Hangouts have said that their products will help physicians comply with HIPAA and that they will enter into a HIPAA BAA.
Additional information can be found at this notice from Department of Health and Human Services (HHS).
COVID-19 Virtual Care
Q: Will Cigna allow in-network providers to provide virtual care?
Yes. We are making it easier for all customers to be treated virtually by their physicians who have the ability to offer virtual care. Providers can deliver virtual care to all Cigna customers when the services are billed consistently with the guidance. We are implementing this enhanced measure through May 31, 2020 to protect our customers by mitigating exposure risks and alleviating transportation barriers.
We are also working on a permanent Virtual Care Reimbursement Policy that will continue to allow providers in our network to offer virtual care after June 1, 2020. More information about this policy will be shared with providers in the coming months. In the meantime, our COVID-19 virtual care guidance will remain in effect until at least May 31, 2020.
Q: How will Cigna cover virtual care for COVID-19 related services?
When providers follow the billing guidance, we will cover virtual care as follows:
For COVID-19 related screening (i.e., quick phone or video consult):
- By a contracted physician in Cigna’s network: No cost-share for customer
- By a virtual vendor (e.g., Amwell or MDLive): No cost-share for customer
For non-COVID-19 related services (e.g., oncology visit, routine follow-up care)
- By a contracted physician in Cigna’s network: Reimbursable at standard office visit rates.
- By a virtual vendor (e.g., Amwell or MDLive): Reimbursable at standard rates currently in place today.
Reimbursement for COVID-19 Virtual Visits
Phone calls for COVID-19 (e.g.: 5-10 min virtual visit with or without video with the licensed health care provider)
- HCPCS code G2012 will be reimbursed without customer copay or cost-share.
- In agreement with CDC recommendations one of the following ICD10 diagnosis codes should be billed:
- For cases where there is a concern about a possible exposure to COVID-19, it would be appropriate to assign the code Z03.818: Encounter for observation for suspected exposure to other biological agents ruled out.
- For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code Z20.828: Contact with and (suspected) exposure to other viral communicable diseases.
- This billing requirement and associated reimbursement applies to claims submitted on CMS 1500 claim forms or its electronic equivalent only.
All other virtual visits
- CPT® code 99241 will be reimbursed for all other synchronous real-time virtual visits when billed with Place of Service 11.
- If the visit is related to COVID-19, the above-mentioned ICD10 diagnosis codes (Z03.818 or Z20.828) are required to be billed and reimbursement will be without customer copay/cost-share.
- If the virtual visit is not related to COVID-19, the ICD10 code for the visit should be billed and reimbursement will be made according to applicable benefits and related cost share.
- No virtual care modifier should be billed
- This billing requirement and associated reimbursement applies to services submitted on CMS1500 claim forms or its electronic equivalent only.
Q: Will Cigna waive customer co-pay and cost-sharing requirements for in-network services related to COVID-19 physician visits?
Yes. All customer co-pay and cost-share for any in-network screening and diagnosis related to COVID-19 will be waived. This includes:
- The initial COVID-19 screening (virtually, in an office, or at an emergency room, urgent care center, “drive thru” specimen collection center, or other facility)
- Testing (i.e., specimen collection by clinician)
- Laboratory test (i.e., performed by state, hospital, or commercial laboratory)
The visit will still be covered without customer cost-share if the provider determines that the visit was consistent with COVID-19 screening purposes. The provider will need to code appropriately to indicate COVID-19 related screening.
Updated guidance for Behavioral Health Telehealth: