Tag: #telehealth

Posted in Insurance, Training

Telemedicine/Telehealth Benefit Updates: Aetna, UHC, EmblemHealth, Cigna

Posted on by KR2Medical Billing

Temporary Telehealth Policy Updates:

Updated on 06/01/2020-AETNA

1. Aetna will waive member cost sharing for any Diagnosis related telemedicine visit- Commercial Type Plans

2. For outpatient behavioral and mental health counseling services-Aetna is waiving cost sharing for Commercial  Type Plans.

3. For telephone ONLY services- Aetna will cover Commercial Type Plans until 08/04/2020- but the cost sharing waiver will end on June 4/2020. Included services are:  …”minor acute care evaluation and care management services, as well as some behavioral health services…”

Updated 05/31/2020-UHC

1. For non-COVID 19 related telemedicine,Virtual Check-Ins Electronic Visits (e-visits),Physical Therapy (PT), Occupational Therapy (OT),  Speech Therapy (ST),  Chiropractic Therapy Home Health and Hospice Remote Patient Monitoring-UHC will waive member cost sharing until 06/18/2020-for Individually Insured, Fully Insured and Group Market Health Plans.

2. Telehealth Expansion- ONLY applies towards the plans that already have the telehealth benefit.

   -Medicare Advantage-Expanded through Sept 30,2020

   -Individually Insured, Fully Insured and Group Market Health Plans-expanded through July 24,2020

Updated on 05/12/2020-EmblemHealth

1. There is no end date for telehealth services- Emblem only stated the following:

 “This change in policy is effective until the end of the COVID-19 public health emergency or sooner as permitted by law and will be communicated through all appropriate channels”.

2. EmblemHealth is waving member cost sharing for all plan types

3. No telehealth modifier needed for 98966-98968 and 99441-99443

Updated on 06/1/2020-Cigna

1.Cigna will extend their member cost sharing waiver until 07/31/2020. However this policy applies to members with Individual and Family Plans (IFP). Additionally, for IFP and Medicare Advantage customers only. Services include non COVID-19 primary, specialty, and behavioral health care.

2. Other Commercial Plans- member cost sharing is NOT waived.

3. Services have to performed ONLY by INN providers

https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html

Posted in Insurance, Payers and CPT reinbursement, Training

UnitedHealthCare COVID-19 Physical , Occupational and Speech Therapies Telehealth Coverage- update 04/20/2020

Posted on by KR2Medical Billing

As of 04/20/2020 UHC announce that it will cover PT, OT and ST services for its members. enrolled in Medicare Advantage, Medicaid, Individual, and Fully Insured Group Market Plans.

This applies to services performed between 03/18/2020 and 06/18/2020

Q.Covered Services?

A. The services have to rendered using interactive live audio-visual technology. During the live video conferencing both parties must be present- patient and the provider.

Q. What is NOT covered?

A. E-mailing “stored” exercise videos to the patient and using a phone to review or discuss them with the patient.  

The providers have to be certified in the given state, where they are providing the service.

Cost sharing will be waived for the services performed by IN-Network providers only. There is an Opt-in option for self funded employers.

Billing & Coding:  Applies to all lines of business.

The complete list of acceptable/reimbursable CPT codes could be found by clicking HERE.

Services that are billed on HCFA 1500 form with modifier 95 with a Place of Services where the services would be furnished in person.

Services that are billed on UB04 should be billed with revenue code 780.

Utilization Management:

There is no change to the utilization management requirements for PT, OT, ST.

Please remember that the claims will be processed based on UHC member’s benefits plan.