Watch for Payer Telehealth Coverage ChangesJune 3rd, 2020 - Wyn Staheli, Director of Research
It has certainly been a roller-coaster ride as everyone has attempted to keep up with all the rapidly changing rules. As our country moves forward with a phased approach to reopening, be sure to pay close attention to individual payer policies regarding how long these changes will remain in effect. Keep in mind that private payer, federal programs (Medicare, Medicaid), and Medicare Advantage plans can all have different timelines as well as different coverage.
For example, on May 31, 2020, United Healthcare updated their COVID information page to reflect some policy changes. They will reimburse doctors of chiropractic for the following services when rendered using live video-conferencing while a patient is at home:
- E/M office/outpatient visit: 99201, 99203-99205, 99211-99213
- Therapeutic procedures: 97110, 97112, 97116, 97530, 97535
- Tests and measurements: 97750, 97755
- Orthotic/prosthetic management/training: 97760, 97761
The dates for these services vary depending on the plan:
- Medicare Advantage: March 18, 2020 through Sept. 30, 2020
- Medicaid: Depends on the state so watch those dates carefully and be aware of other state-specific rules for codes
- Individual and fully insured group market health plans: March 18, 2020 through July 24, 2020
In comparison, coverage by Excellus BlueCross BlueShield is different. You can bill E/M codes (99201-99205) for a new patient, but they won’t cover E/M for an established patient. For established patients, there are some other services (e.g., assessment for lower back pain) which may be reimbursed. For these telehealth services, coverage extends “from March 13, 2020 until the State of Emergency has been lifted.”
Since each state will determine their own ending of the “State of Emergency” and each payer — even different plans offered by that payer — can have different timelines, providers will need to pay close attention. Signing up for newsletters from the payers most commonly billed by your organization can help. At the very least, carefully watch their websites for changes in policies.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
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