The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
BCBS Plans Telehealth Policy PT and OT
The expansion of telehealth services is effective March 1, 2020, through June 1, 2020. We will begin a monthly review process on May 1 to determine whether a continuance is needed.
This expansion applies for patients who wish to receive their care remotely and limit their exposure. It can also serve as an initial screening for patients who may need to be tested for the coronavirus.
Member cost-sharing (copayment, deductible, co-insurance) will be waived for all identified telehealth services, regardless of whether there is a diagnosis related to COVID-19. Always check eligibility and benefits through ProviderAccess or your practice management system to confirm cost-sharing details.
Telehealth Billing Guide for Providers – Updated 4/17/2020
Alaska – Premera
Premera is following CMS guidance on telehealth payments during the COVID-19 health crisis. Providers who normally bill POS 11 for a patient in-office visit should continue to use POS 11 for telehealth visits and the procedure code appended with either modifier 95 or GT (GT can't be used for a Medicare claim). This allows claims to process for reimbursement consistent with an in-office visit during the public health emergency. This change is in effect through June 30, per CMS guidance. We'll be reviewing claims back to March 6 and will remit any additional funds due.
This guidance is in effect during this public health emergency for fully insured group plans, individual, and Medicare plans. FEP, shared admin, and self-funded plans who have opted out of this process are excluded from this guidance.
The payment policy: Telehealth/Telemedicine Services
No specific information on PT and OT
Arkansas Blue Cross and Health Advantage have voluntarily increased overall compensation for telemedicine services for fully insured members by reimbursing all such services at the “office” level. This payment enhancement became effective for these specific services rendered beginning April 1, and will continue through May 15, at which time the policy will be revisited.
There will be no waiver of cost share (e.g. copays, deductibles, and coinsurance) for these services and all contractual limitations, conditions, policies, and procedures will apply. Codes must be submitted with place of service 02 and modifier 95 or GT to indicate billing of a telehealth service. Appropriate documentation commensurate with the level of service provided and submitted for payment is to be placed in the medical record.
Only the following codes will be reimbursed for telemedicine. Telephonic codes do not apply.
Codes: Home Health and Therapy procedures as appropriate
Modifiers: Need to be billed with a GT or 95 modifier
POC: Telehealth (02) Home (12)
Eligible Providers: CareCentrix Home Health Contracted Providers
Effective Date: 3/15/2020
Physical and Occupational Therapy
Modifiers: Need to be billed with a GT or 95 modifier
POC: Telehealth (02)
Eligible Providers: CareCentrix Home Health Contracted Providers Qualified Health Care Professionals in PT, OT or ST
Effective Date: 3/15/2020
List of Physical Therapy / Speech Therapy / Occupational Therapy / Dietician Health Codes: 97161-97168
G2061-G2063 (Medicare Advantage Only)
G0108 (Medicare Advantage Only)
Effective March 19, 2020, BCBSIL began providing benefits to fully-insured members for health care services provided by in-network and out-of-network providers for all medically necessary covered services and treatments consistent with the terms of the member’s benefit plan. Providers of telehealth may include, but are not necessarily limited to, physicians, physician assistants, APRNs, licensed behavioral health, applied behavioral analysis, physical therapy, occupational therapy, and speech therapy service providers, as well as nutritionists and dieticians. Any telehealth visit, whether in-network or out-of-network, for services related to COVID-19 will not be subject to benefit preauthorization requirements.
This telehealth delivery method for health care services is available to eligible fully-insured and employee plan participants in BCBSIL’s PPO and Blue Choice PPOSM plans. Telehealth benefits for medically necessary services are also available to eligible HMO members from providers in their medical group who offer telehealth (benefit plan requirements still apply, e.g., PCP referral requirements). BCBSIL will reimburse providers for medically necessary services delivered via telehealth billed on claims with appropriate modifiers (95 and GT) in accordance with the member’s benefits for covered services.
Posted April 6, 2020
Blue Cross and Blue Shield of Illinois (BCBSIL) is temporarily extending approvals on services with existing prior authorizations until Dec. 31, 2020. This applies to services that were originally approved or scheduled between Jan. 1, 2020 and April 1, 2020. The extension is for certain non-emergent, elective surgeries, procedures, therapies and home visits.
Effective 04/16/2020, therapist can bill the following codes for virtual services:
Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes
Qualified nonphysician healthcare professional online assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes
Qualified nonphysician qualified healthcare professional assessment service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes
Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
During this crisis, any credentialed network physical, occupational or speech therapist can provide limited telehealth encounters to replace office visits.
If your provider specialty appears on this list (List includes PT and OT):
For the duration of the National Public Health Emergency related to COVID-19, Blue is waiving some requirements in this reimbursement policy allowing for the following: • Telehealth may be provided to both new and established patients • Telehealth may be provided over the phone, without the requirement of the visual component • Telehealth may be provided over a non-HIPAA compliant audio-visual application, such as Skype or FaceTime.
Due to COVID 19 Pandemic these codes are temporarily added to the policy with a start date of 2/4/2020 for the duration of the national public health emergency. When billing Medicare professional claims for non-traditional telehealth services for the duration of the Public Health Emergency (PHE), bill with the Place of Service (POS) equal to what it would have been in the absence of a PHE, along with a modifier 95, indicating that the service rendered was actually performed via telehealth. As a reminder, CMS is not requiring the “CR” modifier on telehealth services.
Licensed therapy providers may perform covered medically necessary therapy services via telemedicine.
Health care providers who offer the service through two-way, live interactive telephone and/or digital video consultations may provide medically necessary, covered telemedicine services, based on state statutes.
In addition to the current telemedicine services that are allowed by Montana statute, the following telephonic codes are accepted by BCBSMT for medically necessary, covered services provided by licensed health care professionals, including behavioral health therapy services, until April 30, 2020, and may be extended further based on the status of the COVID-19 crisis.
The following compensation schedule for covered audio-only visits is effective March 11, 2020 until April 30, 2020 and may be extended further based on the status of the COVID-19 crisis.
These codes and prices are:
DR - Disaster Related - For Institutional Billing
CR - Catastrophe/Disaster Related - For Physician & Institutional Billing
After much consideration, BCBSNE has made the decision to adjust our telehealth policy to cover - without copayment – all telehealth services from qualified health care providers, including dentists, within the BCBSNE network at 100% of the assigned fee schedule from March 13, 2020, through June 30, 2020.
BCBSNE will accept telehealth charges from any credentialed provider with no video component required during this pandemic urgency period.
A provider may bill using E&M codes, therapy codes or telehealth codes and must use the modifier 95 and POS 02 for reimbursement. All codes will be covered at 100% of the provider’s existing fee schedule.
Notice of termination for this policy will be given in writing at least 60 days prior to termination. However, we will review and consider an extension for this policy as needed.
Please see the updated telehealth policy in the General Policies and Procedures Manual.
Please use in place of service 02 and modifier 95 with the appropriate CPT codes. We have updated the fee schedule to reflect these changes. To download the fee schedule, please log in to NaviNet.
These changes are specific to BCBSNE members; please check benefits for FEP or out-of-state Blue Cross and Blue Shield members. For coverage information on other Blue Cross and Blue Shield Plans, as well as the BCBS Federal Employee Program (FEP), related to COVID-19 treatment go to bcbs.com.
BCBSNE will allow facility claims submitted on a UB for Telehealth. Please use modifier 95 to identify such claims.
Providers performing and billing teleservices must be eligible to independently perform and bill the equivalent face-to-face service.
Our members may seek telehealth services through their current physician/provider, or they can receive services through AmWell. This information has been communicated separately to our members.
As we continue to partner with you, we want to thank you for the care you provide our members, especially in times of crisis.
Eligible providers: Providers performing and billing telehealth services must be eligible to independently perform and bill the equivalent face-to-face service.
Services using telemedicine technologies between a provider in one location and a patient in another location, may be reimbursed when all of the following conditions are met:
• The patient is present at the time of service;
• All services provided are covered benefits under the member certificate of coverage/benefit booklet, and are eligible for separate payment when performed face to face;
• All services provided are medically appropriate and necessary;
• A service provided to a member located in North Carolina is rendered by a provider licensed to practice independently in the state of North Carolina;
• The encounter satisfies the elements of the patient-provider relationship, as determined by the relevant healthcare regulatory board of the state where the patient is physically located; • The service takes place via an interactive audio and video telecommunications system. Interactive telecommunications systems must be multi-media communication that, at a minimum, includes audio and video equipment permitting real-time consultation among the patient, consulting practitioner, and referring practitioner (as appropriate);
Note in response to the COVID-19 outbreak: To report audio/telephonic only modalities, append modifier -CR (Catastrophe/disaster related) to the applicable service code, and indicate Place of service -02. These changes will also be in place for thirty (30) days starting March 6, 2020. They were extended for an additional 30-day period starting on April 6, 2020, and will continue to be re-evaluated every 30 days for further extension.
• The service is conducted over a secured channel with provisions described in Policy Guidelines;
• A permanent record of online communications relevant to the ongoing medical care and follow-up of the patient is maintained as part of the patient’s medical record;
• The extent of any evaluation and management services (E/M) provided over the Telemedicine technology includes at least a problem focused history and straight forward medical decision making, as defined by the current version of the Current Procedural Terminology (CPT®) manual.
Telehealth services must be reported with place of service code 02
Modifier GQ— (Via asynchronous telecommunications systems). Service codes will not be allowed when modifier –GQ is appended. (See the member’s benefit booklet regarding availability of member benefits for asynchronous telehealth services. Some member benefits may offer additional telehealth access through specialized vendor services.)
Use of Modifier GT (Via interactive audio and video telecommunications systems) and Modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) are optional. (CMS no longer recognizes GT modifier.)
BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan are actively monitoring the rapidly evolving international coronavirus (COVID-19) pandemic. As a result, physical therapists, occupational therapists and speech therapists are temporarily permitted to apply for telehealth services. Physicians must use simultaneous audio and video to bill for telehealth services, although their systems do not have to be HIPAA compliant.
To apply, please complete the Virtual Care Services application located on SouthCarolinaBlues.com and email the completed application to firstname.lastname@example.org.
To see a listing of the CPT codes that are included, see CAM 176. Please keep in mind that the CPT codes must be submitted with the 95 modifier.
NOTE: Telemedicine therapy visits will count towards the member’s therapy visit limits/maximums (if applicable).