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South Central Billing / Reimbursement Updates

The following is a list of billing and reimbursement updates for telehealth and telemedicine within the South Central region (Arkansas, Mississippi, and Tennessee). Source: RuralMED

June 2024

The South Central Region Virtual Visit Billing Guides have been updated with the most recent payor changes. Below is this quarter's most recent updates, or click on any state to go directly to that state's guide.

The quarterly updates for the Arkansas, Tennessee, and Mississippi Virtual Visit Billing Guides have arrived!  A significant update occurred for UHC Community Plan, as a completely revised Virtual Visit Telehealth Policy was issued.  The new policy aligns with CMS and AMA appendix P allowable telehealth services, and also made changes to modifier and POS requirements.  Commercial UHC also had a small change, with the addition of G9037 to their Remote Patient Monitoring allowable code list.  Lastly, Cigna also issued a few updates to their Remote Physiologic Monitoring medical policy, which included the addition of G0322.  Otherwise, payor policies remained stable!

 

The details of the changes are below:

CIGNA

  • Updated the Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) Medical Policy
    • Removed S9110 and added G0322, The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring)
    • Added policy statement for self-measured blood pressure monitoring
    • Removed policy statement criteria requiring FDA approval/clearance

Revised policy statement for RPM for any other indication

UHC

Added HCPCS G9037 to their CTBS-and-Remote-Physiologic-Monitoring-Eligible-Code-List

  • HCPCS G9037: Interprofessional telephone/internet/electronic health record clinical question/request for specialty recommendations by a treating/requesting physician or other qualified health care professional for the care of the patient (i.e., not for professional education or scheduling) and may include subsequent follow up on the specialist’s recommendations; 30 minutes

UHC Community Plan of Tennessee

  • New Policy! Allows telehealth services recognized by CMS and the AMA Appendix P
  • Telehealth modifiers required
    • Modifier 95 for AMA Appendix P codes
    • Modifier GT, GQ, or G0 for CMS telehealth codes
  • POS codes optional

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