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Independence BCBS Telehealth Policy PT and OT

Update: 4/19/2020

The telemedicine services are eligible for reimbursement consideration by the Company when the above criteria are met and the services are performed via the telemedicine modes indicated below.

Service Type

Modes of Telemedicine Delivery

Primary Medical Care

Audiovisual (Interactive, synchronous (real-time), Telephone/online digital

Specialty Medical Care

Audiovisual (Interactive, synchronous (real-time), Telephone/online digital

Behavioral Health

Audiovisual (Interactive, synchronous (real-time), Telephone

Behavioral Health - Applied Behavioral Analysis

Audiovisual (Interactive, synchronous (real-time) only

Medical Nutrition Therapy

Audiovisual (Interactive, synchronous (real-time), Telephone

Outpatient Physical Therapy/ Occupational Therapy

Audiovisual (Interactive, synchronous (real-time) only

Outpatient Speech Therapy

Audiovisual (Interactive, synchronous (real-time) only

Urgent Care

Audiovisual (Interactive, synchronous (real-time) only

Home Care - Skilled Nursing for remote patient monitoring, which must include capabilities that include monitoring vital signs and weight

Audiovisual (Interactive, synchronous (real-time) only

Home Care - Physical Therapy

Audiovisual (Interactive, synchronous (real-time) only

Home Care - Occupational Therapy

Audiovisual (Interactive, synchronous (real-time) only

Home Care - Speech Therapy

Audiovisual (Interactive, synchronous (real-time) only

Home Care - Medical Nutrition Therapy

Audiovisual (Interactive, synchronous (real-time), Telephone

Home Care - Social Services

Audiovisual (Interactive, synchronous (real-time), Telephone

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the professional provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

BILLING REQUIREMENTS

Eligible 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.

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.

PROCEDURE CODES

Primary Care / Specialty Care

99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99421, 99422, 99423, 99441, 99442, 99443

Behavioral Health

90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90846, 90847, 96116, 96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171, 97151, 97155, 97156, 97157, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99231, 99232, 99233, 99307, 99308, 99309, 99310, 99354, 99355, 99356, 99357, G0406, G0407, G0408, G0425, G0426, G0427, G0459

Medical Nutrition Therapy

97802, 97803, G0270

Physical / Occupational Therapy

97110, 97112, 97116, 97129, 97130, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97533, 97535

Speech Therapy

92507, 92508, 92521, 92522, 92523, 92524, 92607, 92608, 92609, 97129, 97130, G0153, G0161, S9128, S9152

Urgent Care Providers

S9083

MODIFIERS

95, GT

REVENUE CODES

Home Care - Social Services

0561, 0562

Home Care - Nurse

0551

Physical Therapy

0420, 0421, 0422, 0424

Occupational Therapy

0431, 0432, 0434

Speech Therapy

0441, 0442, 0444

Home Care - Medical Nutrition Therapy

0590

Intensive Outpatient Services

0905, 0906

Partial Hospitalization

0912, 0913

Reference

http://medpolicy.ibx.com/policies/MPI.nsf/872889ed03971afc8525750800571e91/7f79a9cc4531698a8525853b0068a428!OpenDocument



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