Innovista Health Solutions is dedicated to facilitating the spread of accurate, regularly-updated information regarding COVID-19.

Please select your payer from the list below, or review the entire article for information on multiple payers.

Medicare (Traditional)
Aetna (National)
BCBS – Texas
BCBS – Illinois
CIGNA (National)
Humana (Texas and Illinois)
United (National)
WellCare (Texas)

 

Medicare (Traditional)

Last Update: 03/20/2020

Overview

Notes

Source

CMS has broadened access to Medicare telehealth services on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

Effective for services starting March 6, 2020, and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.

·  Telehealth visits are considered the same as in-person visits and are paid at the same rate.

·  Beneficiaries may receive telehealth services in any healthcare facility and in their home.

·  The HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Medicare Telemedicine Health Care Provider Fact Sheet – 3/17/2020 Update
Medicare Telemedicine Health Care Provider Fact Sheet

CMS Medicare Learning Network – Telehealth Services 3/2020 Update
Telehealth Services

List of Telehealth Services Payable Under the Medicare Physician Fee Schedule

List of Telehealth Services

Aetna (National)

Last Update: 03/25/2020

Overview

Notes

Source

For the next 90 days (06/04/2020) Aetna will cover minor acute evaluation and management services rendered via telephone. A visual connection is not required.

Self-insured plan sponsors will be able to opt-out of this program at their discretion.

·  Aetna offers zero co-pay telemedicine visits for any reason.

·  Cost sharing will be waived for all virtual visits through Aetna-covered Teladoc offerings and in-network providers delivering synchronous virtual care (live video conferencing) for all commercial plan designs.

·  For general medicine and behavioral health visits – a synchronous audiovisual connection is still required.

COVID-19 Coverage

Telemedicine and Telehealth Reimbursement Policy

BCBS – Texas

Last Update: 04/01/2020

Overview

Notes

Source

Effective 03/10/20, BCBSTX is temporarily expanding coverage for medical and behavioral health telemedicine and telehealth visits for insured plans regulated by the State of Texas – identified by a “TDI” or “DOI” printed on the member identification card.

We are continuing to evaluate the evolving state and federal legislative and regulatory landscape relating to COVID-19 and will continue to update our practices accordingly.

·  Telemedicine visits covered as a regular office visit for providers who offer the service through 2-way live interactive telephone or digital video consultations.

·  In-network professionals will be reimbursed at least the same rate for a telemedicine service when provided in-person.

·  No member cost-sharing for covered, medically necessary medical and behavioral health services delivered via telemedicine or telehealth by a qualified in-network provider.

COVID-19 Coverage
BCBSTX Provider Information on COVID-19 Coverage

Telemedicine and Telehealth Coverage Telemedicine and Telehealth Coverage Expansion Document

Clinical Payment/Coding Policies (see Telehealth)Clinical Payment and Coding Policies

The MDLIVE physician network provides telephonic telehealth services to Blue Advantage HMOSM, Blue Advantage PlusSM HMO, and Blue Choice PPOSM fully insured members by calling (888) 450-1572 or going to MDLIVE. Some plans may use other vendors for telemedical/telehealth services. Benefits should always be verified before providing services.

BCBS – Illinois

Last Update: 03/27/2020

Overview

Notes

Source

BCBS of Illinois has made a recent announcement that effective immediately, ALL codes and services that can be provided via telehealth, will be a covered and payable service for all BCBS of Illinois Commercial HMO members under Blue Advantage, Blue Precision, HMO Illinois, and Blue Focus plans.

Billing Information

  • CPT/HCPCS Coding – As stated above, bill with the appropriate – CPT/HCPC codes for telehealth services outlined above and as per the Commercial or Medicare-approved codes;
  • Place of Service – In order to receive the highest reimbursement at the non-facility rate, we recommend that you bill with place of service 11;
  • Modifier – You must attach a 95, GT, or GQ modifier to the CPT/HCPC Code.

Reimbursement Information

Reimbursement will be paid according to your current agreement with IPA name. Reimbursement will be paid at the non-facility rate as long as you bill with place of service 11; if the claim is billed with any other place of service, the claim will be processed according to the CMS site of service processing guidelines. If the claim has the appropriate telehealth modifier attached or is a telehealth CPT/HCPC code, there will be no copayment applied to the claim.

Pre-Authorization Information

If the member is seeking testing or treatment for COVID-19, prior authorization has been waived.

Medicare

The BCBS Medicare Advantage HMO Programs is continuing to follow the same telehealth covered services as defined by CMS. Recently, CMS has expanded the listing of covered telehealth services at the link provided.

If you have previously submitted an authorization and the services will now be provided via telehealth, you do not need to contact Innovista to change the authorization to indicate that it will be provided via telehealth.  Previously submitted and approved authorizations will continue to be valid.

Currently, if you are insured by BCBSIL, you can:

·  Access provider visits for covered services through telemedicine or telehealth as outlined in your benefit plan.

·  You won’t pay copays, deductibles, or coinsurance on in-network covered telemedicine or telehealth services.

COVID-19 Coverage             COVID-19 Coverage for Members

Telehealth Expansion      Telehealth

Approved CMS Telemedicine Codes and Guidelines  
List of Telehealth Services

 

CIGNA (National)

Last Update: 03/30/2020

Overview

Notes

Source

CIGNA updated its interim virtual care billing guidelines allowing providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19.

Claims will be processed consistent with these rules beginning April 6, 2020, for dates of service on or after March 2, 2020, and until at least May 31, 2020.

·  Providers can perform services for commercial Cigna customers in a virtual setting and bill as though the services were performed face-to-face. They will be reimbursed consistent with their typical face-to-face rates.

·  Providers can also bill code G2012 for a 5-10-minute phone conversation, and Cigna will waive cost-share for the customer.

COVID-19 Coverage
Cigna’s Response to COVID-19

Interim Telehealth Guidance
COVID-19: Interim Telehealth Guidance

To provide additional support for the medical community, Cigna will deploy hundreds of on-staff clinicians, including physicians and nurse practitioners, to join the team of healthcare professionals at MDLIVE, a leading telehealth company, and Cigna network partner.

Humana (Texas and Illinois)

Last Update: 03/23/2020

Overview

Notes

Source

Effective March 6, 2020, Humana is waiving member cost share for all telehealth services delivered by participating/ in-network providers. This applies to Medicare Advantage, Medicaid, and commercial employer-sponsored plans. Humana Commercial HMOs is continuing to follow the same telehealth covered services as defined by CMS.

Billing Information

  • CPT/HCPCS Coding – As stated above, you must bill with one of the most appropriate CMS-approved telehealth CPT/HCPC codes.
  • Place of Service – In order to receive the highest reimbursement at the non-facility rate, we recommend that you bill with place of service 11.
  • Modifier – You must attach a 95, GT, or GQ modifier to the CPT/HCPC Code.

Reimbursement Information

Reimbursement will be paid according to your current agreement with IPA name. Reimbursement will be paid at the non-facility rate as long as you bill with place of service 11; if the claim is billed with any other place of service, claim will be processed according to the CMS site of service processing guidelines. If the claim has a COVID-19 diagnosis code, the copay will be waived.

Pre-Authorization Information

Humana has made the following changes to their prior authorization rules:

  1. COVID-19 Diagnosis – if the member is seeking testing or treatment for COVID-19 to an in-network or out of network provider, prior authorization has been waived.
  2. All Services Performed with an in-network provider – All prior authorization requirements are waived for any services performed with an in-network provider at this time for any service.
  3. Out of Network Providers – Prior authorization will continue to be required for services referring to an out of network provider.

If you have previously submitted an authorization and the services will now be provided via telehealth, you do not need to contact Innovista to change the authorization to indicate that it will be provided via telehealth.  Previously submitted and approved authorizations will continue to be valid.

·  Humana will waive out-of-pocket costs for telemedicine for the next 90 days.

· This includes in-network providers delivering telehealth services through audio or video.

COVID-19 Coverage
Coronavirus Disease 2019 (COVID-19)

Telehealth Expansion COVID-19: Interim Telehealth Guidance

Frequently Asked Questions About TelehealthTelehealth: Frequently Asked Questions to Support Physicians Working with Humana

Claims Payment Policy

MDLIVE is Humana’s national urgent care telehealth provider for Medicare Advantage and Doctor on Demand is our national urgent telehealth provider for Commercial.

United (National)

Last Update: 03/30/2020

Overview

Notes

Source

Starting March 18, 2020, UnitedHealthcare expanded our policies around telehealth services for Medicare Advantage, Medicaid and commercial members until June 18, 2020.

UnitedHealthcare will waive cost-sharing for in-network, non-COVID-19 telehealth visits for Medicare Advantage, Medicaid and commercial members, with an opt-in available for self-funded employers.

·   Eligible providers can bill telehealth services using interactive audio/video or audio-only, except in the cases where we have explicitly denoted the need for interactive audio/video.

·   Cost-sharing is waived for in-network telehealth visits. According to plan benefits, out-of-network providers also qualify for telehealth.

COVID-19 Coverage
UnitedHealthcare on COVID-19 Concerns

Telehealth Expansion
COVID-19 Telehealth Services

WellCare (Texas)

Last Update:

Overview

Notes

Source

WellCare is increasing the scope and scale of our use of telehealth services for all products for the duration of the COVID-19 emergency.

 

·   Zero liability for member copays, cost-sharing, etc. for telehealth care

·   Telehealth services may be delivered with any connection technology

·  Prior authorization requirements for telehealth services will be lifted for dates of service from 03/17/2020 – 06/30/2020

 

All Other Insurances

For all other insurance plans and BCBS programs, we ask that you please refer to those health plan websites for further information.

Texas Medical Board and Telemedicine During the COVID-19 Pandemic Disaster Declaration

  • TMB: Frequently Asked Questions: http://www.tmb.state.tx.us/idl/A2936385-466D-15D1-0F9E-F486D0491A27
  • Telemedicine may be performed by a physician or health professional acting under the delegation and supervision of a physician licensed in Texas.
  • Includes a temporary expansion for audio-only encounters by telephone for encounters initiated by patients (or patient’s proxy decision-makers) only.
  • Documentation standards are not different than those required for a face-to-face visit.

 

Illinois State Medical Society and Telemedicine During the COVID-19 Pandemic Disaster

 

About Innovista

Innovista Health Solutions is a population health management company that offers management and support services to guide independent physician networks, medical groups, and health systems through the ever-changing landscape of value-based care. With services and toolsets including network development, population health management, delegated services, data reporting, and strategic capital investments, Innovista is structured to help its clients succeed in their Commercial, Medicare, and Medicaid value programs. Innovista is a single resource for physician integrated models to gain access to innovative technology, expert programs, actionable data insights, financial resources, and growth opportunities, to navigate and succeed in value-based and/or risk-based contracts.

 

Innovista Media Contact

Laura Bingham

lbingham@innovista-health.com