Member Cost Share
Waived for all telemedicine PCP visits; Regular cost-sharing will apply to all specialists and ancillary telemedicine services not related to COVID-19 testing.
For high-deductible health plan (HDHP) members, cost-sharing will be waived for COVID-19 testing and primary care telemedicine visits and will be covered before the deductible. Self-funded customers can opt-out of waiving PCP cost-sharing for non-COVID related telemedicine visits.
However, for self-funded health plans, coverage of telemedicine services is provided for COVID-19 testing without member cost-sharing consistent with the federal Families First law.
Telemed/Health Billing Requirements
PCP/Specialist :99201-99205, 99211-99215, 99421-99423 & 99441-99443 (E&M); Behavioral Health: 90785, 90791-90792, 90832-90834, 90837-90840, 90846-90847, 99201-99205, 99211-99215, 99231-99233, 99307-99310, 99354-99357, 97151, 97155-97156, G0406-G0408, G0425-G0427, G0459; Medical Nutrition Therapy: 97802, 97803, G0270; PhysicalOccupational Therapy: 97110, 97112, 97116, 97129, 97130, 97161-97168, 97530, 97533, 97535; Speech Therapy: 92507-92508, 92521-92524, 92907-92609, 97129-97130, G0153, G0161, S9128, S9152; Urgent Care: S9083; w/POS 02. GT or 95 modifier not required. PCPs will need to submit an encounter claim (837P) in order to be compensated for copayments. Commercial members: Eligible providers performing telemedicine services must report the appropriate modifier (Modifier GT or 95) and place-of-service (POS) code 02 (Telehealth) to ensure payment of eligible telemedicine services.
Telemedicine services performed through telephone communication only must report the appropriate POS code 02 (Telehealth) to ensure payment. Use of Modifier GT or 95 will not be required.
Medicare Advantage members: Eligible providers performing telemedicine services must report the appropriate POS code 02 (Telehealth) to ensure payment of eligible telemedicine services.
Additional Billing Requirements:
- Eligible professional providers performing telemedicine services must report the appropriate modifier (modifiers GT or 95) and place-of-service (POS) code 02 (Telehealth) to ensure payment of eligible telemedicine services.
- Telemedicine services performed through a telephone or online digital communication must report the appropriate place of service 02 (Telehealth) to ensure payment. Use of modifiers GT or 95 will not be required.
- Telemedicine evaluation and management reported by facilities billing on a UB-04 claim form, or the equivalent form 837i, should report revenue code 0780 along with an appropriate evaluation and management procedure code appended by the GT or 95 modifier, as needed.
- Telemedicine ancillary services (e.g. PT/OT/ST) reported by facilities billing on a UB-04 claim form, or the equivalent form 837i, should report the appropriate revenue code (shown below) along with the corresponding procedure code representing the service provided appended by the GT or 95 modifier, as needed.
- Inclusion of a code in this News Article does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.
Lab Admin Codes for Testing
Diagnostic testing U0001 & U0002 after 2/4/20; U0003-U0004 after 4/14/20; 87635 as of 3/13/2020; Antibody testing, 86328 & 86769 as of 4/10/2020; LABORATORY TESTING FOR COVID-19 DIFFERENTIAL DIAGNOSIS 86603, 86710, 86756, 87260, 87275, 87276, 87279, 87280, 87301, 87400, 87420, 87501, 87502, 87503, 87631, 87632, 87633, 87634, 87804, 87807, 87809
Swab collection codes - Physicians
HCPCS codes C9803, G2023 and G2024 for collection of SARS-CoV-2 (COVID-19) specimens, including nasopharyngeal swab (NP), oropharyngeal swabs (OP), serum, plasma, or venipuncture whole blood, are effective and must be used for dates of service as of March 1, 2020 and after. SPECIMEN COLLECTION FOR COVID-19 DIFFERENTIAL DIAGNOSIS LABORATORY TESTING S9529, 36400, 36405, 36406, 36410, 36415, 36425, 36420
See policy Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) - Updated May 13, 2020 for full details.
Transition of Care (cpt 99495-99496) and Annual Wellness Visits codes (G0402 and G0438, G0439) permissable to bill under Telehealth policy
These codes are valid for telehealth on CMS, awaiting confirmation of payer-specific rules. New public health emergency telehealth incentive:
- This new incentive is effective April 15, 2020, and will continue throughout the duration of the national public health emergency, plus an additional 30 days.
- Earn $150 when you submit a claim/encounter for a telehealth visit. The telehealth visit must be completed with both audio and visual features. During the visit, providers should review current conditions and symptoms, medications, test results, chronic conditions, and overall health status. The codes that qualify are:
- G0438: Annual Wellness Visit, initial visit
- G0439: Annual Wellness Visit, subsequent visit
Remember, the telehealth claim/encounter must report the appropriate place-of-service code 02 (Telehealth).
- Only Medicare Advantage members on your panel are eligible for this new incentive.
- Only one incentive payment of $150 will be paid per member.
- Payments will be issued on a monthly basis after the claim is processed. Existing ePASS® incentive:
- Earn an additional $175 when you submit an initial electronic SOAP (Subjective, Objective, Assessment, Plan) Progress Note after either a face-to-face or telehealth audio and visual encounter.
ePASS® is still available for you to submit SOAP Progress Notes and is now also accepting telehealth encounters. It is important to document the member’s current and chronic conditions in the assessment and to perform a complete assessment, albeit without the benefit of in-person vital signs. System reviews, current and chronic conditions, new symptoms, test results, and medication reviews should all be part of the telehealth encounter.
- The ePASS® visit must be conducted with both audio and video features to be eligible for payment.
- One ePASS® incentive will be paid per member.
Telehealth Criteria (two-way, telephonic or both)
Telephonic encounters allowed - View IBC Telemedicine Delivery (PDF Download)
Reimbursement will be at the same level as the current applicable contracted office fee schedule for a standard in-office visit including up to level 5 evaluation and management.
6 monts see details on the Utilization Review Guidline COVID 19 grid (PDF Download)
For products with capitation arrangements, services delivered through telemedicine are considered included in capitation with the exception of those services identified in applicable policies identifying fee for service reimbursement.
S9083 - audiovisual only
3/6/2020 - 12/31/2020: Medicare Advantage extended through the duration of the public health emergency
View the IBC Medical Policies Website information.
View the IBC Provider News Center.