This is the latest information by the insurance companies updated August 3rd, 2020.
We will be reviewing insurance carrier information each business day and update when applicable. These policies change constantly so we have included the websites for reference.
Aetna
- Date of service from March 6, 2020 – December 31, 2020
- Place of Service 02
- Modifier 95 or GT in some circumstances
- 99201-99215, 99241-99245 requires audio-visual connection
- G2061-G2063 and 99421-99423 require and audio-visual connection. No modifier required.
- G2010 and G2012 and 99441 and 99443 can be performed audio-visual or telephone. No modifier required.
- 98966-98966 No modifier required.
Aetna Telemedicine Policy: https://apps.availity.com/web/core/vault/vault/v1/files/329044/Kad1BQ9kR/257a4fad-bf26-49c5-86ac-cbdd172d3c6a?cacheBust=1584738526&spaceId=73162546201441548441629200000321
Aetna Therapy Services Updated on 4/9/2020
- Place of service 02
- Modifier 95 or GT
- 97161-97168, 97110, 97112, 97116, 97535, 97755, 97760
- 98970-98972 modifier not required
Reference: Updated policy on file. No weblink available at this time.
Aetna Better Choice Health Florida
- 99421-99423- GT modifier is required
- 99441-99443- CR modifier is required
- 99441-99443- NEW PATIENTS 99441-99443 GC, CR modifiers are required
- G2010- CR modifier is required
Reference: Fax Blast on file- https://www.aetnabetterhealth.com/Florida
Reference: Medicaid Telehealth policy- https://evisit.com/state-telemedicine-policy/florida/
Anthem BCBS Indiana/Wisconsin
- Covering audio and video services from March 17, 2020 – September 30, 2020
- Covering telephone only services from March 19, 2020 – September 30, 2020
- Anthem is covering telephone calls 99441-99443 for members at this time, but does not normally cover them.
- Anthem only lists 99201-99215 as acceptable telehealth visits and require audio-visual.
- Anthem does not address 99421-99423 or G2061-G2063.
- Anthem will not accept telephone only services for therapy
Therapy services added March 27, 2020
- 97161-97168
- 97110, 97112, 97530, 97535 (added April 1, 2020)
Telehealth Services: https://www.anthem.com/docs/public/inline/C-08002.pdf
Reference: Indiana- https://providernews.anthem.com/indiana/article/information-from-anthem-for-care-providers-about-covid-19-6
Reference Wisconsin- https://providernews.anthem.com/wisconsin/article/important-covid-19-update-prior-authorization-and-other-policy-adjustments-6
Reference: Indiana: April 1, 2020 update: https://anthempc-attachments-prod.s3.us-west-2.amazonaws.com/pdf/articles/Information%20from%20Anthem%20for%20Ca…%20-%20in4422.pdf
Reference: Wisconsin: April 1, 2020 update: https://anthempc-attachments-prod.s3.us-west-2.amazonaws.com/pdf/articles/Information%20from%20Anthem%20for%20Ca…%20-%20wi4427.pdf
Cigna New Guidance 3/26/20
Cigna published billing guidance on March 19, 2020 to spell out their virtual visit instructions.
- Date of service beginning March 6, 2020 and December 31, 2020. (Medicare Adv. 10/22/2020)
- Claims cannot be submitted until April 6, 2020
- G2012 will be covered for a 5-10 minute phone conversation
- G2010 Store and forward (updated 4/23/2020)
- CPT codes 99201-99215 by phone, video, or both
- 99421-99423 and G2061-G2063 (updated 4/23/2020)
- Place of service is 11
- Modifier GQ is necessary
- Copays and deductibles will apply
Therapy Guidelines
- Claims cannot be submitted until April 6, 2020
- Place of service 11
- 97161 and 97165 telephonic or audio/visual
- 97162 and 97166 audio/visual
- 97110 (2 unit limit) audio/visual
- 97112, 97116, 97535, 97750, 97755, 97760, G2061-G2063 (updated 4/9/20)
Reference:
Reference:
April 9, 2020
BCBS of Illinois
The latest BCBS of Illinois notice posted March 18, 2020 has the following information
- Dates of service beginning March 11, 2020
- Acceptable CPT codes
- 99213-99215- require audio and visual communication for established patients, with E/M documentation requirements
- 99421-99423- virtual visits that require audio and visual communication
- 99441-99442- telephone calls
- BCBS of Illinois highlights that coverage of these visits will depend on the patients plan coverage, and self-funded plans will choose whether coverage will be available or not.
- 99213-99215 require modifier 95
Florida Blue
- Effective from March 17, 2020 until October 31,2020 (Medicare Adv. 10/22/2020)
- CPT codes 99201-99215- require audio and visual communication for established patients, with E/M documentation requirements
- 99441-99443 (added 4/9/20) coverage ending 9/5/2020
- Place of service 11 for Medicare Advantage (updated 4/22/2020)
- Place of service 02 (updated 4/9/20)
- Modifiers 95 or GT
Reference: https://www.floridablue.com/providers/covid-19-information
Florida Blue Therapy Services
- Effective March 15, 2020 until October 31,2020 (Medicare Adv. 10/22/2020)
- Place of service 02 for commercial claims, place of service 11 for Medicare Advantage claims
- Modifier 95 or GT
- 97161-97168,97110,97112,97116,97530,97535 (added 4/9/2020)
- G2061-G2063- Medicare Advantage only (added 4/9/2020)
Humana
- Effective from March 6, 2020 – December 31, 2020
- Place of service 11
- Modifier 95
- Telemedicine visits for all urgent care needs are fully covered.
- Must be audio-visual or telephone based on CPT code
- 99201-99215, 99241-99245, 99421-99423, 99441-99443
- 98966-98968, 98970-98973, G2010, G2012, G2061-G2063
Humana Therapy Services
- Effective from March 6, 2020 – December 31, 2020
- 97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760 See Medicare updated on 4/30/2020
- According to CMS therapists can perform G2010, G2012, G2061-G2063, 98966-98968
Reference: Telehealth Policy https://www.humana.com/provider/coronavirus/telemedicine
Reference: 4/9/2020 update: Policy number CP2020002 on file and located in this weblink: https://docushare-web.apps.cf.humana.com/Marketing/docushare-app?file=3923140
Illinois Medicaid
- Place of service 02
- Modifier GT
- 99421-99423, G2010, G2012, G2061-G2063
Reference: https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200320b.aspx
Reference: https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200330d.aspx
Indiana Medicaid
- Effective March 1, 2020
- Modifier GT
- Place of service 02
- Can be audio only
- 99201-99215- no modifier
Reference: http://provider.indianamedicaid.com/ihcp/Bulletins/BT202022.pdf
Reference:http://provider.indianamedicaid.com/ihcp/Publications/providerCodes/Telemedicine_Services_Codes.pdf
Reference:https://www.in.gov/medicaid/files/telemedicine%20and%20telehealth%20services.pdf
Reference: http://provider.indianamedicaid.com/ihcp/Bulletins/BT202037.pdf
Reference: http://provider.indianamedicaid.com/ihcp/Bulletins/BT202034.pdf
IU Health Plan
Effective March 6, 2020 IU Health Plan will reimburse for any diagnoses the following visits.
- 99201-99215
- 99421-99423
- G2010, G2012
- G2061-G2063
- This policy does not address place of service or modifiers.
Medicare – Ending 10/22/2020
- 99441-99443 will be covered by Medicare
- 98966-98968 will be covered by Medicare
- 99201-99215 office visits
- G2010 and G2012
- 99421-99423
- 99441-99443- (updated to telehealth list 4/30/20)
- Place of service 11
- Use modifier 95 for all services that are audio/visual, 99201-99215, 99441-99443, 98966-98968
- 98966-98968 are not reported with modifier 95 but should be reported with CR (updated 4/21/2020)
Reference: Telehealth codes March 1, 2020 https://www.cms.gov/Medicare/Medicare-General-
Information/Telehealth/Telehealth-Codes
Reference: Telehealth Fact Sheet March 30, 2020 https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf
Reference: Interim Rule https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-
emergencies/coronavirus-waivers
Reference: Update 4/21/2020 Modifier CR https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-
IDOZm2K5TG9SKHUUp1a05dOL4DRXrBFGP16U4cRL4M8m5edzZ5zsmezEMM9xHW6E-
on=Jurisdiction%206&LOB=Part%20B#
Reference: Update 4/30/2020- https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf
https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf
Modifier 95 information from NGS updated 5/14/2020
Medicare Therapy Services
Updated April 30, 2020
- 97161-97168
- 97110,97112, 97116, 97530
- 97535- Can be performed audio only (4/30/20)
- 97750, 97755, 97760
- G2061-G2063 are not reported with a modifier 95 (updated 4/21/2020)
- Place of service 11
- Modifier 95
Reference: March 31, 2020: https://www.cms.gov/files/document/covid-final-ifc.pdf
Reference: March 31, 2020: https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf
Reference: Update 4/21/2020 See above reference for modifier 95
4/30/2020 Update see above
Northshore University Health Systems-Illinois
Therapy Services
- Coverage from 4/3/20-4/30/20
- Modifier 95
- 97161-97168, 97110, 97112, 97116, 97535
PHCS
See Medicare
United Healthcare
United Healthcare’s latest update is from March 19, 2020
- This will be effective March 18, 2020 through October 22, 2020
- Require audio and visual communication except for telephone calls (updated 4/8/20)
- Place of service 11 (updated 4/3/2020)
- Modifier 95 is needed for office visits 99201-99215
- Codes covered are 99201-99205, 99212-99215, 99421-99423, G2061-G2063
- 99441-99443 and 98966-98968 are covered (updated 4/8/20)
Update March 23, 2020
United Healthcare will also cover virtual check-in codes G2010 by telephone and G2012 by captured image or video.
Update March 27,2020
Platforms not approved for telehealth by UHC. Facebook Live, Twitch, Snapchat, TikTok
Approved platforms approved for telehealth by UHC. Apple Facetime, Facebook Messenger video chat, Google Hangouts video, Skype
Therapy services- Benefits will be processed in accordance with the member’s plan.
- Therapy services accepted from March 18, 2020 through October 22, 2020
- Place of service 11
- Modifier 95
- Physical therapy 97161,97162,97163,97164,97110, 97116, 97530, 97112, 97535
- Occupational therapy 97165, 97166, 97167, 97168, 97110, 97530, 97112, 97535
- UnitedHealthcare will reimburse claims including one of the CPT® codes from the list.(4/3/2020)
Telehealth and Telemedicine Policy:
March 27, 2020 Update
Therapy services added: https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-services-telehealth.html
April 3, 2020 Update:
lic%2Fresources%2Fnews%2F2020%2FTelehealth-Patient-Scenarios.pdf
Updated May 13, 2020 https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2020/Telehealth-Patient-Scenarios.pdf
April 8, 2020 Update:
https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-pt-ot-st.html99441-99443, 98966-98968-
https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-services-virtual-visits.html
Illinois Work Comp
- No effective dates given
- Modifier 95 should be used
- No place of service information given
- 99201-99215, 99212-99215, 99241-99245
Illinois Work Comp Therapy
- No effective dates given
- Modifier 95 should be used
- No place of service information given
- 97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760