As we're nearing the end of 2020 and the widespread availability of a COVID-19 vaccine is in sight, there are many questions patients and physicians have regarding how to continue providing care. Most insurances implemented temporary coverage for telehealth during the pandemic, which has proven to be a literal life saver for some patients and has allowed practices to remain afloat financially. However, insurances are slowly changing their guidelines and putting more fiscal responsibility back on the patients with applying copay/co-insurance/deductibles on many telehealth visits and no longer covering specialist visits via telehealth. Below are some changes that have occurred recently, or will begin in 2021:
As of October 1, 2020, Harvard Pilgrim has re-implemented patient copays/co-insurance/deductibles for telehealth visits.
As of January 1, 2021, Tufts will begin applying patient copays/co-insurance/deductibles for telehealth visits.
As of January 1, 2021, Cigna will accept the 95, GT and GQ modifiers instead of requiring GQ. Make sure you pick the modifier applicable to how services were rendered (synchronous, asynchronous, etc.).
As of January 1, 2021, United wants "02" used as the place of service code for their commercial products and the applicable 95 or GT modifier. Prior to this, they wanted to see the place of service code reflect where the patient would have been seen if it was a face-to-face visit, i.e. "11", "31", etc. Medicare Advantage plans still want the place of service code to be office, nursing home, etc. with a 95 modifier.
As of February 1, 2021, Aetna will re-start cost-sharing for telehealth.
Of course, this is not a full list and these guidelines are subject to change. All insurance plans have different rules and regulations, so always check with your provider rep (if available) and stay up to date on new releases from the insurances.
The good news is that CMS has recognized the impact telehealth has had and will likely change their prohibitive guidelines on it once the health crisis has ended. If CMS continues to pay for telehealth, other insurances will follow suit. In the meantime, let's do our part to keep each other safe and utilize telehealth whenever possible.
If you have any questions about these changes, or any billing questions during the pandemic, reach out to us! We are happy to help via call or email.
Premier Medical Billing, LLC
617-270-5328
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