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Vantage Health Plans Telehealth Policy PT and OT

Update: 4/19/2020

Physical Therapy (PT), Occupational Therapy (OT), and Speech Language Pathology (SLP) Telemedicine Visits for all patients:

Telemedicine visits must be performed in lieu of a face-to-face visit.

Telemedicine visits must be billed with the CPT codes and the appropriate modifiers traditionally billed for on-site face to face visits. CPT codes eligible for telemedicine include: 97161 97110 97530 97165 92507 92521 92524 92610 96105 97162 97112 97535 97166 92522 92526 97164 97116 97168 92522

These codes must be billed with a POS (place of service) of 02 instead of POS 11.

The limit on billable units previously stated in Notice #3 are no longer applicable.

Vantage will pay these telemedicine visit claims at the same rate as in-office visits with NO Patient Cost Share.

Physical Therapy (PT), Occupational Therapy (OT), and Speech Language Pathology (SLP) In-Home Encounters for all patients:

The following complex evaluation codes and hands-on CPT codes that require face-to-face encounters can now be performed in the patient’s home as an in-home encounter: 97014 97032 97035 97140 97163 97167

These in-home encounter claims must be billed with POS 12 (private residence).

The services listed in item (1) above may also be performed in-home and billed as POS 12.

Vantage will pay all in-home encounter claims at the same rate as in-office visits with applicable patient cost share.

Physical Therapy (PT), Occupational Therapy (OT), and Speech Language Pathology (SLP) General Information:

  • All claims should include all acute and chronic diagnoses.
  • Current pre-authorization requirements apply.
  • Documentation for all claims should be similar to that of face-to-face office visits with respect to medical necessity and treatment specifications. Encounters should be fully documented in the patient’s medical record.

Reference

https://www.vantagehealthplan.com/documents/Physicians/VantageProvidersCOVID19Update.pdf?q=637207591001817595


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