Telemedicine in COVID-19

Telemedicine

AMS is receiving multiple calls each day regarding what carriers are and are not allowing in light of COVID-19. We will be working on matrix to help understand and hopefully will have that ready soon. For now, see below for a summary.

3\27 Update:  COVID-19 COVERAGE Provisions for Telephone-Only

  • Medicaid
      • E/M Visits covered using telemedicine including telephone only.
      • Use the appropriate CPT code with a GT modifier and a POS 02.
      • Dates of Service on or after March 18th and for at least 60 days.
      • Virtual Check-ins covered using G2012; effective April 1 for dates of
        service on or after 3/18/20.
  • ABCBS
    • E/M Visits covered using telemedicine including telephone only.
    • Use appropriate CPT code with GT or 95 modifier and POS 02.
    • Retroactive to 3/16/20 and going at least until 5/15/20.
      • This has been extended through July 25, 2020.
    • Copays, coinsurance and deductibles waived for all telemedicine
      services.
  • Ambetter/Qualchoice
    • E/M Visits covered using telemedicine including telephone only.
    • Use appropriate CPT code with a POS 02.
    • Copays, coinsurance, and deductibles waived for all telemedicine
      services.
  • United
    • Through June 18, 2020, UnitedHealthcare will waive the Centers for Medicare and Medicaid’s (CMS) originating site restriction and audio-video requirement for Medicare Advantage, Medicaid and commercial members. Eligible care providers can now bill for telehealth services performed using audio-video or audio-only, except in the cases where we have explicitly denoted the need for interactive audio/video such as with PT/OT/ST, while a patient is at home. Click here to read the entire telehealth statement.
  • Medicare
    • 5/1 – CMS will be increasing payments for audio-only telephone visits between Medicare beneficiaries and their physicians to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110, and the payments are retroactive to March 1, 2020.
  • Cigna
    • E/M Visits covered using telemedicine including telephone only.
    • Use the appropriate CPT code with a GQ modifier and POS 11.
    • Quick consults – 5-10 minutes to talk to patients about screening or other issues; use code G2012.
  • HumanaRead updates to existing telehealth policy here. .

TECHNOLOGY – The Office of Civil Rights has relaxed the HIPAA compliant technology requirements so that tools such as FaceTime and Skype can now be used.

EXISTING TELEMEDICINE RULES – Do not forget that Arkansas law already requires all insured plans, including Medicaid, Arkansas Works and State Employee plans to cover services provided via telemedicine technology. Why is this important? For those health plans that are not allowing office and other visits such as medication management visits to be billed when using “telephone-only”, if you provide the service using other telemedicine communication technologies you can still bill for that service. The information below applies to coverage for telemedicine services according to Arkansas statute:

  • The originating site is defined as wherever the patient is located, including the home.
  • Does not include telephone only, FAX, texting, or email
  • Health plans must cover AND provide reimbursement for services provided via telemedicine on the same basis as in-person visits and reimbursement can be no less than it would have been under an in-person visit.
  • The service provided via telemedicine must be comparable to what would have been provided in person. Example: make sure your documentation supports the billed CPT code such as a 99213.
  • The health plan cannot prohibit a physician (provider) from directly billing a patient for a telephone-only visit that would not otherwise be covered by the carrier.
  • Under the relaxed rules from the Office of Civil Rights, we understand that, for now, real-time audio and video would include Facetime and Skype. Again, documentation is important.

3/23 – HIPPA Allowances for Telemedicine Technology: The Division of Medical Services at DHS issued a memo on 3/23 regarding HIPPA requirements during COVID-19 outbreak. Physicians who use audio or video to provide telemedicine during this emergency can use any non-public facing remote communication product that is available to communicate with patients. This 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.

Under this notice, covered providers may use popular applications that allow for video chats, including Apple FaceTime,  Facebook Messenger video chat, Google Hangouts video, and Skype. Click here to view the entire DMS statement.