Posted in My services, Training, Updates

UHC Updated Telemedicine/Telehealth Policy for 2021

Effective of 01/01/2021– UHC will change its Telehealth/Telemedicine Policy

This policy will apply to Oxford Plans as well

The following is the reimbursement policy for Telehealth/Telemedicine services:

-The only POS (place of service) that will be allowed is 02 (UHC: this is consistent with the Centers for Medicare and Medicaid (CMS) billing and reimbursement guidelines.)

-Modifiers 95, GT or G0 may be appended to telehealth claims reported with POS 2, BUT will not necessary be used to identify the telehealth services instead they are considered informational.

-UHC will consider the home of the member as an originating site for eligible services

 – Various codes will be eligible for consideration under the policy including the code list listed in the current policy, as well as similar types of services rendered using interactive audio and video technology.  (Please see the partial tables below)

-Certain physical, occupational and speech therapy (PT/OT/ST) telehealth services will be considered for reimbursement when performed by a qualified health care professionals and using interactive audio and video technology.

– The policy addresses additional ways of provider-patient communications including E-visits, remote patient monitoring (non-face-to-face, patient initiated communications, like online portals)

– Payment will align with applicable state law.  

Source: (UHC October provider bulletin)      
For full list of covered codes please click here
Posted in My services, Training, Updates

NC Primary Care Providers can get paid for COVID-19 testing of Uninsured Patients

On 10/30/2020- NC HHS Department has created an online portal for Primary Providers to submit COVID-19 claims for uninsured patients.

This is a first-come first-serve reimbursement to primary care providers who are providing COVID-19 related primary care services to uninsured individuals living in North Carolina*. Per the federal CARES act.

In order to qualify the provider must be:

  1. Primary Care
  2. Operate in North Carolina
  3. Participate in NC Medicaid Program
  4. Be registered in NCTracks payment portal


Providers must attest to the following at registration:

• Providers have checked for health care coverage eligibility and confirmed that the patient is uninsured. Providers have verified that the patient does not have coverage through an individual, or employer-sponsored plan, a federal health care program, or the Federal Employees Health Benefits Program at the time services were rendered, and no other payer will reimburse you for COVID-19 testing and/or care for that patient

* Providers will accept defined program reimbursement as payment in full

• Providers agree not to balance bill the patient

• Providers agree to program terms and conditions and may be subject to post-reimbursement audit review


Providers will receive $150 per eligible visit.

Reimbursement Process:  

1. PCPs should confirm their enrollment as a provider in the NCTracks system. Enrollment can be completed in the portal.

2. PCPs should perform COVID-19 related services (e.g. follow-up care) for patients as usual.

3. PCPs must ensure the patient does not have insurance to be eligible for the program, PCPs should use the NCTracks portal to complete the attestation form to file the claim. Attestation will serve as verification of eligibility.

NCTracks Attestation Form includes the following language:

By submitting this transaction to the NC Department of Health and Human Services, I attest that the service performed is accurately represented as shown, and the patient was uninsured, and the service was a COVID-19 related primary care service. I further attest that claims have been either submitted to the HRSA portal and denied or were not submitted because they were ineligible for HRSA reimbursement. I understand this transaction is a request for payment from CARES Act funding and is subject to audit by the Office of the State Auditor and other oversight organizations.

4. PCPs should regularly file claims in the provider portal. If the claim has been successfully filed in NCTracks and there are still funds available, PCPs will be reimbursed in subsequent NCTracks check writes issued by the Division of Health Benefits.

Official Press Release from NCHHS, please click here!

Posted in In The Know Series, My services, Training, Updates

Empire NYSHIP Plans and member cost-sharing for diagnostic allergy and asthma testing: year 2020 and beyond

This post is for Allergy & Asthma providers that accept Empire NYSHIP (TPA UHC) patients and perform diagnostic asthma/allergy testing in the office setting (POS 11).

Commonly used CPT codes in Office Setting (w/ short description)

1. 95004- skin prick allergy testing

2. 95024- intradermal allergy testing

3. 95044- patch allergy testing

4.95018- Medication (Penicillin) allergy testing

5. 94200- Peak flow

6. 95012- NIOX or FENO

Member cost-sharing/patient co-pays for year 2020 and beyond:

Most of the Empire NYSHIP plans (there are various types), have updated their co-pay to $25 per office visit (specialist) Please click here to visit my post on the updated Empire NYSHIP co-pays.

However, as recent as last year, the Empire NYSHIP plans also started to add, an extra $25 member cost-sharing fee, to the above mentioned CPT codes. In order for your office not to leave this uncollected revenue on the table, please make sure to inform your front office staff of this change!  

Now  let’s take a look at 2 (TWO) examples.

Ex. 1. Patient comes in for the first time and has the environmental skin prick testing done the same day. The billing would be:  99204 25 with 95004X40 -the total patient financial responsibility would be $50: $25 for OV and $25 for testing.

Ex. 2. Patient with DX of Allergic Asthma (J45.30) is coming in for a follow up visit. The billing would be: 99213 25 with 94200 59 and 95012 59. In this instance the second co-pay would be applied to 94200 and 95012 would be paid. So, the patient will still pay only $50 co-pay.

Now, If you have any more questions about this post, Empire NYSHIP patients cost-sharing or something else, please go on my (SERVICES) page and contact me for a free 30-min Evaluation ($250 Value).