Billing Telehealth Updates for the South Central Region – November 2020

The South Central Telehealth Resource Center is committed to assisting you through the complexities of billing telehealth through the COVID-19 pandemic. As the pandemic continues to unfold, the ability to remain nimble to provide care and still obtain accurate reimbursement is critical for financial stability. The Virtual Visit Billing guides for Arkansas, Mississippi, and Tennessee, originally released in the Summer, have been updated and newly formatted!

These guides were created to save you time and provide information and education about virtual visits.  It is a lot of information to absorb! We often find in our work with organizations that there is no “one size fits all” solution.  Each unique set-up and situation must be considered in formulating the best plan for your organization. If you would like some support in a plan, please reach out to us and we would be glad to discuss how we can help.

• Arkansas Virtual Visit Billing & Coding Guide (rev. 10.30.2020)
• Mississippi Virtual Visit Billing & Coding Guide (rev. 10.30.2020)
• Tennessee Virtual Visit Billing & Coding Guide (rev. 10.30.2020)

Providing a quick, high-level overview of the recent updates, all payors have extended their telehealth flexibilities to either December 31st, 2020, or the end of the current federal Public Health Emergency (PHE), which is currently set to end on January 21st, 2021.  The federal PHE can only be extended 90 days at a time and, therefore, may extend past January 21st, 2021.  Payors are also beginning to limit or end their cost-sharing waivers; however, most have kept cost sharing for COIVD-19 related visits.

Below are more detailed key updates for regional and national payors since the guides were originally published.

National Payors

Aetna

• • Telehealth flexibilities extended through December 31st, 2020.
  • Extended their cost-share waiver for in-network behavioral health visits through December 31st, 2020.
    • The cost-share waiver for other telehealth visits ended June 4th, 2020.
  • Several allowable codes were added as of 10/21/2020, including cardiac and pulmonary rehab codes.
  • Telephone services, CPT (99441-99443), were reimbursed at the office visit E/M equivalent through September 30th, 2020, but Aetna has since discontinued that practice, and telephone only services will be reimbursed at pre-pandemic rates.
  • Wellness Services can be billed utilizing appropriate E/M codes with a wellness diagnosis for wellness aspects of the visit done via telehealth will be covered. Preventative visit codes should be billed when routine in-office visits can resume, and the remaining parts of the well-visit can be completed. Both services will be fully reimbursed, and the patient will not incur a cost-share.

Cigna:

• • Telehealth flexibilities extended through December 31st, 2020.
    • Beginning January 1st, 2021, Cigna will implement a new Virtual Care Reimbursement Policy.
  • Extended their cost-share waiver for office visits/telehealth visits related to the assessment and administration of diagnostic testing to January 21st, 2021. Cigna also extended their cost-share waiver for all COVID-19 related treatment to December 31st, 2020.
  • Removed language in their PT/OT/ST policy stating that providers could only utilize CMS covered therapy codes. PT/OT/ST providers can now utilize any code on their allowable fee schedule, as appropriate to be provided via telehealth.
  • Added urgent care information

Medica:

• • Telehealth flexibilities extended through the end of the federal PHE or February 1st, 2021, whichever is later.
  • Extended their cost-share waiver for in-network telehealth visits when related to administration of a COVID-19 test to January 31st, 2021
  • Added required CS modifier information for services relating to the order for or administration of a COVID-19 diagnostic test or for services related to the evaluation of an individual for purposes of determining the need for diagnostic testing.
  • Wellness visits can be provided via telehealth utilizing CPTs 99381-99387 and 99391-99397.

Medicare:

• • Telehealth flexibilities and cost-share waivers continue to extend through the end of the federal PHE
  • Added payable telephone codes (CPT codes 98966–98968), which describe audio-only telephone assessment and management visits for practitioners who cannot independently bill for E/M phone visits, for example, certain therapists, social workers, and clinical psychologists.
  • Added detailed telehealth billing and enrollment information for hospitals

UHC:

• • Extended telehealth flexibilities for in-network telehealth services through December 31st, 2020.
  • Effective October 1st, 2020 ended the cost-share waiver for all telehealth services, regardless of DX. However, UHC will still cover cost-sharing for COVID-19 testing related telehealth through the end of the PHE, and COIVD-19 treatment-related telehealth through December 31st, 2020.

Regional Payors

ARKANSAS

BCBS of AR:

• • Extended telehealth flexibilities and cost-share waiver through January 21st, 2021.

Arkansas Medicaid:

• • Telehealth flexibilities and cost-share waivers continue to extend through the end of the federal PHE
  • RHCs and FQHCs should begin utilizing G2025 with POS 02 beginning August 28th, 2020

MISSISSIPPI

BCBS of MS:

• • Extended telehealth flexibilities through December 31st, 2020
  • Effective July 1st,2020 BCBS MS has discontinued their cost-share waivers for telehealth and will apply member cost-share to telehealth services.

Mississippi Medicaid:

• • Telehealth flexibilities and cost-share waivers continue to extend through the end of the federal PHE
  • Increased telephone reimbursement to be similar to office visit E/M reimbursement.

TENNESSEE

BCBS of TN:

• • Continued telehealth and cost-share waivers until further notice.

Tennessee Medicaid & MCOs:

• • Extended telehealth flexibilities and cost-share waivers through December 31st, 2020.

Call us to talk more about how the South Central Telehealth Resource Center can support your organization’s telehealth program. Call 1.888.664.3450 or email us at info@learntelehealth.org.

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About the author(s)

Our guest contributor is Hayley Prosser, Director of Revenue Cycle Services, ruralMED Revenue Cycle Resources. Ms. Prosser, along with Ms. Shelly Cassidy, Vice President of Revenue Cycle Services, are trusted advisors to the SCTRC and our service region, and have developed the three state-focused Virtual Visit Billing Guides and webinars now available in the “Regional Resources” section of LearnTelehealth.org.