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Regence Telehealth Policy PT and OT

Update: 4/19/2020

Telehealth expansion

We have temporarily expanded medical and behavioral health telehealth services. This expansion will remain in effect through each state’s emergency declaration.

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

Telehealth services can be provided if the services:

  • Are safely and effectively delivered via telehealth
  • Meet the code definition that is billed when provided via telehealth
  • Meet existing coverage criteria, including pre-authorization requirements and medical necessity
  • Are conducted using U.S. Department of Health and Human Services’ (HHS’) lead on discretion with respect to HIPAA compliant platform requirementsPulsara offers a free, HIPAA-compliant, video-enabled platform.

Individual and group members

  • For claims to process correctly and for you to receive reimbursement consistent with an in-office visit, you must use:
    • The place of service (POS) where the services would have normally occurred (excluding POS 02).
    • Modifier 95 to indicate that the services were rendered via telehealth.  (This update was made to align to the most recent guidance from CMS.)
  • Telehealth services are covered for our Individual, group (including administrative only services groups who have opted in to the telehealth expansion) and Medicare Advantage members. View instructions for verifying ASO groups who will temporarily cover virtual services to replace in-person visits.
  • The member's coinsurance and deductible will apply to the telehealth service, if applicable. Note: The telehealth visit related to COVID-19 testing will be covered at no member cost share. See below for information about coverage for COVID-19 testing.

Medicare Advantage members
To align with the most recent CMS guidance:

  • For claims to process correctly and for you to receive reimbursement consistent with an in-office visit, you must use:
    • The place of service (POS) location where the services would have normally occurred (excluding POS 02).
    • Modifier 95 to indicate that the services were rendered via telehealth.
      • Note: For Medicare Advantage claims that were previously submitted with modifier GT, please submit corrected claims with modifier 95.
  • For the encounter to meet the Medicare telehealth face-to-face requirement, telehealth visits with your Medicare Advantage patients must be conducted using real-time via audio and video, and the use of audio and video must be documented in the patient’s chart note.
  • The member's copay, coinsurance and deductible will apply to the telehealth service, if applicable.** Note**: The telehealth visit related to COVID-19 will be covered at no member cost share. See below for information about coverage for COVID-19 testing.
  • Telehealth services can be provided to Medicare Advantage PPO members by out-of-network providers.

Telehealth benefits
We will continue to cover the medical and behavioral health codes for our Individual, group and Medicare Advantage members, as outlined in our Virtual Care (Administrative #132) reimbursement policy. Claims submitted following the guidelines in this policy, including the use of POS 02, will be paid as they have been. View instructions for verifying members' telehealth benefits.



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