Telehealth Policy Updates - COVID - 19
Most Americans are glad that we are closing the book on this week! It has been a wild week economically and from a practice management perspective, but there are many things to be thankful for and that we can celebrate together.
Commercial and government insurance continues to make wide-sweeping changes to their telehealth policies and the last few days are no exception.
• “Effective January 1, 2020, our policy will cover telemedicine services for members enrolled in all Aetna commercial plans. We’ll reimburse for two-way, real-time audiovisual interactive communication between the patient and the health care practitioner” • “Reimbursement will be the same as if the service was rendered face-to-face.” • Prior to March 6th, 2020, client copays were the same as they are for face-to-face visits. However, “as of March 6, 2020, Aetna will offer zero co-pay telemedicine visits for any reason for 90 days, until June 4,2020” • “The claim should be billed with one of the following modifiers: GT: Telehealth service rendered via interactive audio and video telecommunications system 95: Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system” • NOTE from BG: It is unclear if out of network providers will be covered. On the Aetna website under “What You Need to Know About the Coronavirus (COVID-19), assessed 3/16/20 , it stated: “For the next 90 days, until June 4, 2020, Aetna will offer zero co-pay telemedicine visits – for any reason. Aetna members should use telemedicine as their first line of defense in order to limit potential exposure in physician offices. Cost sharing will be waived for all virtual visits through the Aetna-covered Teladoc® offerings and in-network providers delivering synchronous virtual care (live video-conferencing) for all Commercial plan designs. stated telehealth sessions were for “virtual visits provided through the Aetna-covered Teladoc® offerings and in-network (emphasis mine) providers delivering virtual care for all Commercial plan designs,” so it is unclear if out of network providers are covered for telehealth, even during this health emergency.
One of the questions on the page was: “Would you be willing to open access to in-network levels of care on out-of-network providers for the period of this potential pandemic?” And the answer given was “We are currently evaluating this within the parameters of how we handle other disasters, e.g. hurricanes, floods, wildfires. However, unlike natural disasters, the COVID-19 is not limited to a specific geographic area, which makes this situation more complicated. We are working with both network and out-of-network providers throughout the country to render care to members in the best possible ways based on the volumes of patients seeking services and appointment availability within a specific geographic area.” Doesn’t sound like a definite “yes” to me. • Self-insured employers can opt-out of this program, so telehealth (or free telehealth) benefits may not apply to all your clients. f you have questions, or have a specific member for whom you would like to check coverage, it was suggested that you contact Aetna, provide the patient’s name and ID number (and probably date of birth) along with your question at https://www.aetna.com/health-care-professionals/forms/contact-us-online.html (I received a quick response) or possibly email firstname.lastname@example.org. • Aetna phone numbers: 1-800-624-0756 (for HMO plans); 1-888-632-3862 (for Traditional plans); 1-877-480-4161 (for Aetna Student Health plans)”
Sources: correspondence to author from email@example.com March 12, 2020, in response to author’s question; also, What You Need To Know About the Coronavirus, Aetna Website, https://www.aetna.com/individuals-families/member-rights-resources/need-to-know-coronavirus.html
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.”
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
From email to provider from California Network Relations, 3/17/20: “I can speak to your Anthem Mental Health Network Commercial individual agreement. Services for Telemedicine are allowed under your Anthem agreement in your professional office for psychotherapy. Services need to be provided through a secure, HIPAA compliant mechanism (no Facetime or Skype) and in live, real-time audio/visual capability.” “Telemedicine for patient psychotherapy is the delivery of mental health care services through telecommunication technology, videoconferencing.” “Technology would not include telephone, text or email consultations, FaceTime, SKYPE, etc.”
Patient would need to have the benefit specifically for telemedicine or not be an excluded benefit.Providers rendering psychotherapy to members in CA must be licensed and have an active private practice in CAA provider cannot be contracted just for TelemedicineTelemedicine does not apply to ABA service.Service must be a service that could also be rendered in person and on payment schedule
Billed according to contract, along with the GT modifierPlace of service for Teleheath is 02
The following are examples of services not eligible for reimbursement as Telehealth services.
ABA service are not eligible for telemedicine servicesNon-direct patient care (e.g. coordination of care before or after patient interaction)Services rendered by audio-only telephone or mobile phone calls, facsimile, email or any other non-secure (not HIPPA approved i.e. FaceTime or Skype) electronic communication.Anthem will not reimburse any provider for Telehealth Services delivered through a medium that does not meet the requirements.Any services not eligible for separate reimbursement when rendered as in-person services
Follow these steps:
Immediately before the Scheduled Appointment:
Confirm you have obtained verbal consent from the patient and it is documented in the patient’s record/file. Answer all questions the patient may have about the Telehealth process. Gather the necessary Telehealth materials (i.e. clinical data, patient file /medical records). Confirm that the Telehealth program (HIPPA compliant audio visual secure portal) is working properly.
During the Patient’s Appointment, be cognizant of the following: Maintain a professional environment that respects the patient’s privacy and confidentiality. Limit distraction by eliminating background noise as much as possible. Prevent unknown people from entering the room during the psychotherapy /consultation. Post Consultation and Documentation
After you complete the psychotherapy/consultation, perform the following: Mute the audio and disconnect the phone call. Maintain all information from the Telehealth psychotherapy/consultation as part of the patient’s medical record or file to substantiate the services provided and to indicate that services were rendered via Telehealth. “
Source: email to two providers from Nicole Smith, Network Relations Consultant, Sr., Provider Solutions l California Commercial Behavioral Health. CABHNetworkRelations@Anthem.com
2. “Telemedicine services must be provided on a HIPPA compliant audio visual secure portal. This would not include FaceTime, SKYPE, telephonic etc. Patient would need to have the benefit specifically for telemedicine or not be an excluded benefit.
Providers rendering care to members in CA must be licensed in CATelemedicine must be through a secure, HIPAA compliant mechanism (no Facetime or Skype)Live, real-time audio/visual capabilityService must be a service that could also be rendered in personBilled according to contract, along with the GT modifier
As a Commercially contracted provider please e-mail your questions to Behavioral Health Network Relations at: CABHNetworkRelations@anthem.com“
Source: Ann Frank, Provider Network Mgr 1, Anthem Inc, 9655 Granite Ridge Drive, Suite 600, San Diego, CA 92123 , O: (858) 571-8215. firstname.lastname@example.org
ANTHEM BLUE CROSS 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. email@example.com, EAPProviderNetworks@anthem.com,
ANTHEM (not California)
Anthem announcement 3/17/20: “For 90 days, Anthem’s affiliated health plans will waive any member cost share for telehealth visits, including visits for mental health, for our fully insured employer plans, Individual plans, Medicare plans and Medicaid plans, where permissible. Cost sharing will be waived for members using Anthem’s telemedicine service, LiveHealth Online, as well as care received from other telehealth providers delivering virtual care. Access to LiveHealth Online as well as virtual care via text is available to members through the Sydney Care app. Self-insured plan sponsors will have the choice to participate in this program.”
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
BEACON HEALTH OPTIONS
“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, firstname.lastname@example.org. www.beaconhealthoptions.com
2. ” 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
3. 3/17/20 Email from Beacon provider: “I called Beacon – for Northern CA it is the Great Lakes Service Center for Provider Services 855-847-8347 and they told me that there are internal discussions about telemental health going on and no decisions have been made! The follow-up number is going to be 800-397-1630 for Provider Relations. I signed in to the Beacon provider web pages and nothing.”
Note from author: I have been unable to get substantive telehealth coverage info for psychotherapy from this plan yet. Check back to this website and I will update as it comes in. If you have received any written plan information outlining current telehealth policy, please contact me.
“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. Consistent with the California Department of Healthcare Services Information Notice 20-009, Beacon Health Options will permit providers to deliver clinically appropriate, medically necessary covered services to Medi-Cal Members via telephone or telehealth (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 Medi-Cal members:
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 email@example.com
BLUE CROSS BLUE SHIELD FEDERAL EMPLOYEES PROGRAM MENTAL HEALTH/SUBSTANCE ABUSE (MHSA)
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.”
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 PPOSM 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 PlansSM (BCCHPSM) (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:
Psych diagnostic evaluation
Psych diagnostic evaluation w/medical services
Psychotherapy 30 min
Psychotherapy 30 min w/e&m evaluation
Psychotherapy 45 min w/e&m evaluation
Psychotherapy 60 min
Psychotherapy 60min w/e&m evaluation
Office visit established patient 15 min
Office visit established patient 25 min
Office visit established patient 40 min
Physician /Qualified Health Professional telephone evaluation 5-10 min
Physician /Qualified Health Professional telephone evaluation 11-20 min
Physician/Qualified Health Professional telephone evaluation 21-30 min
Physician/Qualified Health Professional online digital evaluation 5-10 min
Physician/Qualified Health Professional online digital evaluation 11-20 min
Physician/Qualified Health Professional online digital evaluation 21-30 min
Nonphysician telephone assessment 5-10 min
Nonphysician telephone assessment 11-20 min
Nonphysician telephone assessment 21-30 min
QNHP online digital E/M SVC EST PT <7 D 5-10 min
QNHP online digital E/M SVC EST PT <7 D 11-20 min
QNHP online digital E/M SVC EST PT <7 D 21+ min
*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.”
BLUE CROSS/BLUE SHIELD OF MASSACHUSETTS
See complete information on telehealth policies at https://provider.bluecrossma.com/ProviderHome/wcm/connect/7de2d366-27c9-4ef2-9125-5cce9626502c/MPC_082715-2U+Telehealth+Final.pdf?MOD=AJPERES&CVID=Includes this question and answer: “Q: Is behavioral health a part of telehealth services? A: Yes. Some of the most common behavioral health conditions treated with online. therapy include depression, anxiety, stress management, and sleep difficulties. Our contracted behavioral health providers can see their established patients via short telehealth video visits and provide medication management as well. Here are the covered behavioral health codes: Code Narrative 90791 Psychiatric diagnostic evaluation 90792 Psychiatric diagnostic evaluation with medical services 90832 Psychotherapy, 30 minutes with patient and/or family member 90833 Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service 90834 Psychotherapy, 45 minutes with patient and/or family member 90836 Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service 90837 Psychotherapy, 60 minutes with patient and/or family member 90838 Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) 90846 Family psychotherapy (without the patient present), 50 minutes 90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes Required modifier:95 Telemedicine service using a real-time interactive audio and video telecommunications system GT Via interactive audio and video telecommunication systemsNote: We will deny telemedicine claims submitted without modifier GT or 95.
“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.”
BLUE CROSS BLUE SHIELD OF MICHIGAN
“BCBSM will expand access to telehealth and its 24-hour nurse hotline. Given the nature of the COVID-19 epidemic, seeking in-person medical care may lead to further spreading of the virus. BCBSM will encourage the use of virtual care and will also facilitate member access and use of nurse/provider hotlines.” For more information, go to https://www.mibluesperspectives.com/news/blue-cross-blue-shield-of-michigan-will-waive-member-copays-and-deductibles-for-covid-19-tests-among-series-of-proactive-steps-on-coronavirus/
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 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
“HEY CLINCIANS! Video or phone! Tell your patients to stay home and see you by video or phone. We’ll pay for it! Below, you’ll find 4 steps we’re taking to make it easier for you to provide care to your patients. Switch to Virtual ASAP: We will pay for virtual visits at parity including visits through secure video or by phone. On March 6th, we announced we were making telehealth easier for our members and clinicians to use. And, we meant it. You can even use telehealth options in the hospital and ED. Behavioral health too. Click for a detailed guide on clinical scenarios and how to file claims here.”“These changes apply to our fully insured, Medicare, State Health Plan and Federal Employee Program members. Self-funded employer groups will be given the option to apply these changes to their employees’ plans. These …steps took effect on March 6, 2020. They will remain in effect for 30 days and then be re-evaluated.”Source: https://blog.bcbsnc.com/coronavirus-providers/
BLUE SHIELD OF CALIFORNIA
Most Blue Shield of California clients have behavioral health handled by Blue Shield’s MHSA (Mental Health Service Administrator, Magellan. See Magellan listing below or info regarding those clients. If your client is Blue Shield (not Magellan), I’m sorry to report I have been unable to get substantive telehealth coverage info for psychotherapy from this plan yet. Check back to this website and I will update as it comes in. If you have received any written plan information outlining current telehealth policy, please contact me.
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:
-contracted with an insurance carrier – have availability for at least 3 UC Berkeley students – have availability to provide services via telehealth (phone, and/or video)
Please fill in this form: https://docs.google.com/forms/u/0/d/e/1FAIpQLScxNiGuYNXy4FR5S-pJS2CmVExbDI1dZyntMKF_ZL1VJT_iOw/formResponse
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
“Telehealth, is meant for those patients who are unable to get to your office for any reason to have a face to face sessions. You will still need to continue to call to verify benefits – there will be additional communcation sent out on this today 3/16/20 from Cigna Corporate. When you do bill for these type of sessions you would continue to bill under the CPT code you would normally use on your fee schedule but add the GT modifier to your bill (under Field 24-D in claim form). You will be reimbursed at the same amount as that code on your fee schedule. I have also attached a Telehealth Flyer [text pasted below] for your review which covers billing and service resources. In regards to contacting you, Cigna Behavioral Health (CBH) would refer patients to you the same way we have before. If a member calls in for a list of counselors in your area we will refer them according to the member’s needs. Contracted behavioral providers need to attest to meeting the designated specialty requirements before delivering behavioral telehealth sessions to Cigna customers. Upon receipt of the completed form, “telehealth” will be added as a specialty to the provider’s Cigna profile. For your conveinience I have attached attested specialty form in this email. You may review, complete, and sent to: CompletedForms.ProviderNetwork@cigna.com.
You must utilize a secure video-based technology and be appropriately licensed in the state in which the customer is being treated. You also must be aware of relevant practice guidelines developed by any applicable specialty societies as they relate to both in-person and telehealth practice. You are expected to follow federal, state and local regulatory and licensure requirements related to your scope of practice, any limitations on the use of specific technologies and prescribing practices, and need to abide by state board and specialty training requirements. CBH medical necessity criteria (page 51) indicates that providers should be licensed where they are rendering services and in the state where the member is physically receiving treatment. If such services cross state lines, providers may require multi-state licensure. The American Telemedicine Association (ATA), a non-profit organization that serves as an international resource and advocate promoting the use of advanced remote medical technologies, offers additional guidance on technology. Visit www.americantelemed.org for more information. Our front line staff at Provider Services should also be able to support you in this service and further inquiry at 800.926.2273.”
ATTACHED FLYER: “CIGNA INTERIM TELEHEALTH GUIDANCE:” Announcement from Cigna Behavioral Health: “During this time of heightened awareness of the novel Coronavirus, COVID-19, and its recent classification by the World Health Organization (WHO) as a global pandemic, we want to keep you up to date on how Cigna Behavioral Health is working to help support you and your patients with Cigna coverage.
Many behavioral providers have contacted us about delivering telehealth sessions. While we have been reimbursing for telehealth since 2017, we have made some temporary revisions to telehealth requirements to support continuity of care during this unique situation. The following changes are effective March 17, 2020 through May 31, 2020.
Behavioral telehealth sessions are available to patients with Cigna coverage 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.
As a general requirement, Cigna-participating outpatient providers must complete an attestation to deliver telehealth sessions. During this interim period, however, telehealth attestations are notrequired. Please note that regardless of your attestation status, it is expected that you use a secure platform to deliver services and follow all Health Insurance Portability and Accountability Act (HIPAA) requirements.
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. You are required to follow federal and/or state guidance as it evolves for the delivery of telehealth. If you have questions about licensing mandates, please contact the appropriate state licensing board(s).
Behavioral providers who meet telehealth requirements (see above) may deliver services via telehealth with no additional credentialing.
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. Include the following information on your claim form:
Appropriate Current Procedural Technology® (CPT®) code in Field 24-D for the service(s) providedModifier 95** in Field 24-D to specify telehealth (see sample claim form below)Place of Service 02 in Field 24-B (see sample claim form below) If you are rendering services as part of a facility (i.e., intensive outpatient program [IOP], partial hospitalization program [PHP], inpatient), expanded use of telehealth to include psychiatric evaluations, group, or family therapy is permitted at this time, in accordance with current legislative telehealth guidance. Use applicable revenue codes and normal billing procedures. Excluded physician services may be billed separately using the 95 modifier (see above) in cases where the contracted facility rate is not inclusive of psychiatric evaluation charges. There is no separate billing required for therapy sessions, as they are already included in the contracted facility rate. Medical Necessity Criteria for the level of care being delivered must continue to be met.
Please use your existing fee schedule/contract to determine the correct charge. Your reimbursement is the same whether you render face-to-face or telehealth sessions.Additional resources