Telehealth Guidance 2020
Telehealth Resources, Info, and Coverage
VPQHC Telehealth Virtual Office Hours on Wednesdays from 12 pm - 1 pm and Thursdays from 8-9 am
BiState Primary Care Launches Telehealth Bootcamp
This online boot camp is designed to complement the Vermont Telehealth Resources Guide. The strategy is simple - if you’re new to telehealth, then every morning for one workweek, set a timer for 30 minutes, and review one of the five sections below. By the end of the week, you’ll know the basics and be ready to explore the many great resources available to help Vermont health care providers implement a strong telehealth strategy.
On April 30, 2020, CMS lifted Medicare restrictions on the use of telehealth services during the COVID-19 emergency. Key changes effective March 1, and lasting throughout the national public health emergency include:
- Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19.
- Patients can receive telehealth services in all areas of the country and in all settings, including at their homes.
- Increased reimbursement rates for audio-only telemedicine. The change, which is retroactive to March 1, boosts payments for telephonic evaluation and management services (CPT codes 99441-99443) to match those of regular, in-office E/M visits (99212-99214). Payments will increase from about $14-$41 to about $46-$110.
- CMS expanded the list of services eligible to be reported via telehealth (link here)
- CMS will permit reporting of telehealth E/M office or other outpatient visits based on time or Medical Decision Making (MDM).
- The Qualified Healthcare Professionals that are eligible for telehealth has been expanded. Additional codes for these services were also added to the CMS telehealth list.
- CMS has clarified that telehealth services are permitted with both new and established patients.
- Physicians can reduce or waive cost-sharing for telehealth visits. In addition, all cost-sharing for Medicare beneficiaries is waived for COVID19 testing and visits related to the testing. Modifier CS – Cost sharing must be appended to these claims to ensure cost-sharing.
- Physicians licensed in one state can provide services to Medicare beneficiaries in another state. State licensure laws still apply.
Medicare Telehealth and Remote Patient Monitoring (RPM) Services Coding and Guidelines – comprehensive chart 5.4
CMS Physician Fee look-up tool - reimbursement rates by claim
Office of Civil Rights: Telehealth and HIPAA – allowing the use of non-HIPAA compliant audio/video platforms like FaceTime, ZOOM, Skype
Tips & Notes
- Telephone only Codes: covered (during an emergency only), limited to 98966-98968; 99441-99443
- Virtual Check-in Codes covered, G2012; G2010 (5-10 min.)
- Modifiers - Add 95 for all telehealth services and usual POS code; Add CS for 100% reimbursement of Covid-19 testing E&M visits or virtual visits (whether or not testing was performed)
- Patient Consent necessary - can be verbal
- Prior authorization - necessary only when necessary for in-person
- DVHA COVID-19
- DVHA Vermont Medicaid Payments for Telephonic Services During the Emergency to COVID-19 - Updated 4.9 Start with March 13, 2020, as the service date and March 23, 2020, as the claim's date
- Vermont Medicaid Payments for Telephonic Services Furnished During the Emergency Response to COVID-19: Reference Charts - 4.9
- FAQs for Medicaid Reimbursement for Telehealth for COVID-19 - 3.27
- Vermont DFR memo regarding COVID-19 and Telemedicine Services
- Vermont DFR Emergency Rule Re: Telehealth Coverage
- BCBSVT - New Telehealth Policies As of 4.2.20
- MVP COVID - Policy Changes - 3.30.20
- MVP NY/VT Suspends Prior Auth for Inpatient Care, Skilled Nursing and Rehabilitation Facilities - 3.24.20
- MVP NY/VT Emergency Telemedicine Coding Guidance
- CIGNA COVID-19 Billing Guidance
- CIGNA - COVID-19 Telehealth Coverage
- Excellus - BCBS - COVID-19
- United Healthcare COVID-19 Guidance
- United Healthcare - COVID-19 Telehealth and Telemedicine Reimbursement - Updated 3.23.20
BCBSVT Open Codes for All Virtual Well Child Visits
BCBSVT has agreed to reverse a policy it had in place restricting reimbursement for virtual well-child care to children only over age 2 and will now cover virtual well-child care for all children regardless of age. This change will be retroactive and is due to advocacy led by the AAPVT Chapter in coordination with the Vermont Academy of Family Physicians and the Vermont Medical Society. AAP reminds all pediatric clinicians about following
AAP guidelines for good visits during this time and in the future:
- Well-child care should occur in person whenever possible.
- Well-childcare should be provided consistent with the Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents (4thEdition) and the corresponding Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (Periodicity Schedule).
- Well-child care should occur within the child’s medical home where continuity of care may be established and maintained.
- Where community circumstances require pediatricians to limit in-person well visits:
- Clinicians are encouraged to prioritize in-person newborn care and well visits and immunization of infants and young children (through 24 months of age) whenever possible.
- Well visits for children may be conducted through telehealth, recognizing that some elements of the well exam should be completed in the clinic once community circumstances allow. These elements include, at a minimum: the comprehensive physical exam; office testing, including laboratory testing; hearing, vision, and oral health screening; fluoride varnish; and immunizations.
- HHS Notification of Enforcement Discretion for telehealth remote communications during the COVID-19
- Office of Civil Rights: Telehealth and HIPAA
- Covery's Liability Insurance COVID-19 Guidance
- Northeast Telehealth Resource Center - Select COVID-19 Telehealth Resources firstname.lastname@example.org; Phone: 800-379-2021 or email@example.com
- NGS is available to answer Medicare Telehealth Billing Questions email KATHERINE.DUNPHY@anthem.com
- UVM Telehealth Tips for Providers
- Telemedicine Quick Set-up Guide in Response to COVID-19 National Emergency developed by Drs. Sylvia Romm, Adam Maghrabi, Tisha Rowe, Aditi Joshi
- Optimizing Privacy When Setting Up Facetime Services