Tag: #telemedicine

Posted in MVP (NY/VT) Insurance Payer, Training, Updates

MVP (NY/VT): COVID-19 Treatment and Virtual Care, Cost-Share Update

Posted on by KR2Medical Billing

Below policy will apply to MVP plans that are located in New York and Vermont.

New York Virtual Care Cost-Share: Telemedicine

For MVP Medicare Advantage Plans- MVP will continue to apply the cost sharing waver for audio/visual and audio only until the DOS (dates of service) Dec 31,2021.

For MVP Commercial Plans- Starting August 1,2021 and thereafter the patients will have to pay their “in-person visit” cost-share for audio/visual and audio only visits according to their plan details.

Vermont Virtual Care Cost-Share: Telemedicine

For MVP Medicare Advantage Plans- MVP will continue to apply the cost sharing waver for audio/visual and audio only until the DOS (dates of service) Dec 31,2021.

For MVP Commercial Plans- Starting August 1,2021 and thereafter the patients will have to pay their “in-person visit” cost-share for audio/visual and audio only visits according to their plan details.

New York Covid-19 Treatment member Cost-Share:

Effective August 1, 2021, MVP will no longer waive the cost-share for COVID-19 treatment.

***Vermont Covid-19 Treatment member Cost-Share: ***

MVP will continue to cover COVID-19 treatment in full until March 1, 2022 as is required by
Vermont Rules.

COVID-19 Testing Member Cost-Share: NY &VT

MVP will continue to cover COVID-19 testing in full in New York and Vermont

COVID -19 Testing Coding and Billing Corner:

As of January 1, 2021 claims billed with a diagnosis code Z03.818 in conjunction with a COVID19 testing procedure code will be denied

MVP will retain the expanded set of codes eligible for telehealth, consistent with CMS guidance, and will continue to monitor state and federal guidelines and regulations. In addition, MVP supports continued telehealth reimbursement and is currently reviewing coding guidance.

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Posted in My services, Training, Updates

UHC Updated Telemedicine/Telehealth Policy for 2021

Posted on by KR2Medical Billing

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 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