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Anthem BCBS Telehealth Policy PT and OT

Update: 4/16/2020

California

What member cost-shares will be waived by Anthem for virtual care through telehealth and telephonic-only?

Effective March 17, 2020, and until further notice, Anthem and its delegated entities will waive member cost share for telehealth (video + audio) visits, including visits for behavioral health, for our fully-insured employer, individual, Medicare and Medicaid plans where permissible. Cost sharing will be waived for members using Anthem’s telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program.

Effective March 19, 2020, and until further notice, Anthem and its delegated entities will cover telephone-only medical and behavioral health services from in-network providers and out-of-network providers. Anthem will waive associated cost shares for in-network providers only except where a broader waiver is required by law.  Self-insured plan sponsors may opt out of this program.

Is the option to deliver services via telehealth available for all types of services?

Yes, until further notice, so long as it is medically appropriate to render the services via telehealth.

Exceptions for Medi-Cal members include chiropractic services, physical, occupational, and speech therapies. At this time the DHCS has not authorized these services for telehealth or telephone.

Does the provider have to be physically present in their office when providing services via telehealth?

No. If the provider can effectively deliver services via telehealth from another location (e.g., the provider’s home), while also maintaining the patient’s privacy the services are payable.

What is the reimbursement rate for telehealth and telephonic-only services?

As required by the State of California, telehealth and telephonic services must be paid at the same rate, whether a service is provided in-person or through telehealth or telephonically, if the service is the same regardless of the modality of delivery, as determined by the provider’s description of the service on the claim.

Can all contracted providers offer telehealth and telephonic-only services to members?

Yes.  All Anthem contracted providers can provide telehealth and telephonic services if clinically appropriate.  

Is Anthem’s vendor, LiveHealth Online, prepared for the number of visits that will increase to telehealth?

As there is a heightened awareness of COVID-19 and more cases are being diagnosed in the United States, LiveHealth Online is increasing physician availability and stands ready to have doctors available to see the increase in patients, while maintaining reasonable wait times.

What is the best way that providers can get information to Anthem’s members on Anthem’s alternative virtual care offerings?

Anthem.com/ca and Anthem’s COVID-19 site (https://www.anthem.com/ca/coronavirus/) are great resources for members with questions and are being updated regularly.

Anthem members have access to telehealth 24/7 through LiveHealth Online. Members can access LiveHealth Online at https://livehealthonline.com/ or by downloading the LiveHealth Online app from the App Store or Google Play.

Anthem members also can call the Anthem 24/7 NurseLine at the number listed on their Anthem ID card to speak with a registered nurse about health questions.

As of March 17, 2020 Anthem and its delegated entities will waive, until further notice, any member cost share for telehealth or telephonic visits provided by in-network provider, including visits for mental health, for our fully insured employer, individual, Medicare and Medicaid plans.  Cost shares will be waived for members using Anthem’s telemedicine service, LiveHealth Online, as well as care received from other telehealth providers. Self-insured plan sponsors will have the choice to participate.

Coding, billing, and claims

How should a provider bill for services delivered via telehealth or telephone during the State of Emergency, when the provider would normally deliver the services in-person?

During the COVID-19 State of Emergency, when a provider delivers a service via telehealth that the provider would normally deliver in-person, the provider should document and bill the service(s) as follows:

  • Thoroughly document the visit as if the visit had occurred in person.
  • Use the CPT code(s) for in-office visit for the particular service(s) rendered. DO NOT USE telehealth or telephonic CPT codes.
  • Use Place of Service “02” to designate telehealth.
  • Use modifier 95 or GT for synchronous rendering of services, or GQ for asynchronous.
    • Medi-Cal Exception – use modifier 95 for synchronous rendering of services, or GQ for asynchronous.

Reference

https://providernews.anthem.com/california/article/information-from-anthem-for-care-providers-about-covid-19-5

Colorado

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139 - 97150, 97533, and 97537-97546.

Reference

https://providernews.anthem.com/colorado/article/information-from-anthem-for-care-providers-about-covid-19-updated-march-20-2020

Connecticut

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) 02 and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139 - 97150, 97533, and 97537-97546

Reference

https://www11.anthem.com/shared/noapplication/f0/s0/t0/pw_g398175.pdf?refer=ahpmedprovider

Georgia

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113- 97124, 97139 - 97150, 97533, and 97537-97546.

Reference

https://anthempc-attachments-prod.s3.us-west-2.amazonaws.com/pdf/articles/Information%20from%20Anthem%20for%20Ca...%20-%20ga4382.pdf

Indiana

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139 - 97150, 97533, and 97537-97546.

Reference

https://providernews.anthem.com/indiana/article/information-from-anthem-for-care-providers-about-covid-19-6

Kentucky

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139 - 97150, 97533, and 97537-97546.

Reference

https://providernews.anthem.com/kentucky/article/information-from-anthem-for-care-providers-about-covid-19-7

Maine

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139 - 97150, 97533, and 97537-97546.

Reference

https://providernews.anthem.com/maine/article/information-from-anthem-for-care-providers-about-covid-19-updated-march-19-2020-1

Missouri

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139 - 97150, 97533, and 97537-97546.

Reference

https://providernews.anthem.com/missouri/article/information-from-anthem-for-care-providers-about-covid-19-8

Nevada

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139 - 97150, 97533, and 97537-97546.

Reference

https://providernews.anthem.com/nevada/article/information-from-anthem-for-care-providers-about-covid-19-updated-march-19-2020

New Hampshire

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139 - 97150, 97533, and 97537-97546.

Reference

https://providernews.anthem.com/new-hampshire/article/information-from-anthem-for-care-providers-about-covid-19-updated-march-19-2020-2

Ohio

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139 - 97150, 97533, and 97537-97546.

Reference

https://providernews.anthem.com/ohio/article/information-from-anthem-for-care-providers-about-covid-19-9

Virginia

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139 - 97150, 97533, and 97537-97546.

Reference

https://providernews.anthem.com/virginia/article/information-from-anthem-for-care-providers-about-covid-19-2

Wisconsin

For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:

    • Physical therapy (PT) evaluation codes 97161, 97162, 97163, and 97164
    • Occupational (OT) therapy evaluation codes 97165, 97166, 97167, and 97168
    • PT/OT treatment codes 97110, 97112, 97530, and 97535
    • Speech therapy (ST) evaluation codes 92521, 92522, 92523, and 92524
    • ST treatment codes 92507, 92526, 92606, and 92609

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139 - 97150, 97533, and 97537-97546.

Reference

https://providernews.anthem.com/wisconsin/article/information-from-anthem-for-care-providers-about-covid-19-10

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