We are referring to the CMS Medicare Telemedicine Health Care Provider Fact Sheet
for our expanded telemedicine coverage guidance effective for dates of service beginning March 6, 2020. Our expanded coverage will remain in effect until further notice.
To support needed provider network adequacy, protect members and providers, and promote access to care, we are offering Zoom meeting licensure to providers without the ability to conduct telemedicine services during the COVID-19 public health emergency. Providers may contact their Provider Network Consultant if they are interested in obtaining a Zoom license to provide telehealth services.
WellFirst Health’s coverage of COVID-19 telemedicine services includes the 85 additional services temporarily added by CMS. In alignment with CMS guidance, these temporary services should be billed with the Place of Service (POS) equal to what would have been billed if not for the public health emergency.
Modifier 95 should be appended to indicate that the service rendered was actually performed via telehealth. Traditional telehealth services should continue to be billed with POS ‘02’.
Our coverage of COVID-19 telemedicine services includes CPT codes 99441, 99442, and 99443 (non-face-to-face telephone services) for all WellFirst Health products. Other telephone-service codes include 98966, 98967, 98968 (qualified non-physician providers) and G2010 (remote evaluation of recorded video or image) and G2012 (Brief communication technology-based service, e.g., virtual check-in). Standard coding and billing rules apply, although, rules surrounding the use of codes for “established patients” only, have been relaxed.
See CMS MLN “Telehealth Services”
for acceptable telehealth CPT codes.
Virtual check-in visits will also be covered during the COVID-19 state of public health emergency. Acceptable codes include G2010 and G2012 for brief telephone check-ins for established patients.
Providers should continue to only bill codes that are on their fee schedules. If you need assistance verifying the codes on your fee schedule or have specific questions on allowable codes other than those listed within our guidelines, contact your Provider Network Consultant.