Payment

• Anthem BCBS Plan added Telehealth
• CareSource announces COVID-19: Temporary Telehealth Services

CMS 

CMS Guidance Allows PTs in Private Practice to Provide Services Via Telehealth

CMS now allows PTs in private practice to make full use of telehealth with their patients under Medicare Part B. Previously, only limited e-visits and other “communication technology-based services” were allowed; the change now includes PTs among the health care providers permitted to bill for real-time face-to-face services using telehealth. This has resulted due to advocacy efforts of APTA members so it goes to show that Advocacy works.

Please click HERE for details.

APTA is seeking clarification from CMS regarding whether hospitals are eligible to bill for telehealth services furnished by PTs, as the language in the interim final rule and accompanying guidance is unclear. Click HERE for the list of waivers for hospitals.

As soon as this information becomes available, it will be shared with members.

A recent CMS rule in response to COVID-19 makes it easier for PTs to furnish certain services using other forms of telehealth that don’t entail live face-to-face interaction. These include e-visits, virtual check-ins, remote evaluation of recorded video and/or images, and telephone assessment and management (medical discussion) services.

• Remote Evaluation of Recorded Video/Images (G2010)
• Virtual Check-In (G2012)
• E-visits (G2061-G2063)
• Telephone Assessment and Management Services (98966-98968)

CARESOURCE

All participating providers are eligible to render services to members following the fact sheet published by CMS in an effort to expand the telehealth benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. CareSource will follow all published regulatory guidance concerning non-participating providers who render telehealth services. All claims will be processed in accordance to the billing guidelines outlined on the CMS fact sheet.

UNITED HEALTHCARE

UnitedHealthcare will reimburse claims including one of the CPT codes from the list, as long as claims are submitted on a CMS 1500 form using the place of service that would have been reported had the services been furnished in person along with a 95 modifier, or on a UB04 form with revenue code 780. These coding rules apply to all lines of business.

Codes accepted from March 18 to June 18 are: 97161, 97162, 97163, 97164, 97110, 97112, 97116, 97530, 97535, 97750, 97755, 97760, 97761

UnitedHealthcare will not reimburse providers for audio-only visits. All visits must be performed using live video-conferencing that involves the presence of both parties at the same time and a communication link between them that allows a real-time audio and visual interaction to take place. E-mailing “stored” exercise videos and discussing or reviewing by phone is not reimbursable.

AETNA

Aetna has advised that telehealth services delivered by physical therapists may be billed on a UB04 using the modifier GT or 95.

CIGNA

See Cigna’s response to COVID-19.

Q: Will Cigna allow for physical, occupational, and speech therapists to provide virtual care?

Yes. PT/OT/ST providers can now deliver virtual care for any service if it is on their current fee schedule and if CMS covers it virtually. We have removed the previous guidance that only a select number of codes on the fee schedule could be billed. PT/OT/ST providers should also submit virtual claims with a GQ, GT, or 95 modifier and a face-to-face place of service code (e.g., POS 11).

Important notes

• While we encourage PT/OT/ST providers to follow CMS guidance regarding the use of software programs for virtual care, we are not requiring the use of any specific software program at this time.
• We maintain all current medical necessity review criteria for virtual care at this time.
• Our national ancillary partner American Specialty Health (ASH) is applying the same virtual care guidance, so any provider participating through ASH and providing PT/OT services to Cigna customers is covered by the same guidance.

Q: Which modifiers does Cigna accept for virtual care visits?

Effective April 06, 2020, Cigna updated its guidance to allow modifiers GQ, GT, or 95 to indicate virtual care for all services. This further aligns with CMS and feedback from our provider partners. Also consistent with CMS, providers should bill their standard face-to-face place of service for virtual care (e.g., POS 11).

This ensures providers can bill a typical face-to-face place of service for virtual care and receive the same reimbursement as they typically get for a face-to-face visit. Please note that billing a POS 02 for virtual services may still result in reduced payment or denied claims due to current Cigna system limitations.

Q: How should providers bill us for virtual care?

Providers can perform services for commercial Cigna customers in a virtual setting and bill as though the services were performed face-to-face. Providers should bill using the face-to-face codes on their fee schedule today, append the GQ, GT, or 95 modifier, and use the place of service (POS) that would be typically billed if the service was delivered face to face (e.g., POS 11).

Q: Can providers who typically deliver services in a facility setting perform virtual services?

Yes. If a provider typically delivers face-to-face services in a facility setting, that provider can also deliver any appropriate service virtually consistent with existing Cigna policies. In these cases, providers should bill their regular face-to-face codes that are on their fee schedule, and add the GQ, GT, or 95 modifier to indicate the services were performed virtually. A provider should bill on the same form they usually do (e.g., CMS 1500) as when they provide the service face-to-face.

For example, if a dietician or occupational therapist would typically see a patient in an outpatient setting, but that service is now provided virtually, that dietician or occupational therapist would bill the same way they do for that face-to-face visit – using the existing codes on their fee schedule and existing claim form they typically bill with (e.g., CMS 1500) – and append the GQ, GT, or 95 modifier.