Which Insurances Cover TeleHealth?
Hey everyone! We’ve been working feverishly to gather information from each payor regarding their specific Telehealth Policies since we know each one can be different. After days of effort collecting information and speaking with provider representatives, I wanted to share the information we have at this time. This is all subject to change and I will keep this article as “up-to-date” as possible with new information. However, we tried to get answers to the following questions from each insurance if possible.
Coverage Questions for Telehealth:
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones?
2. Can we use existing pre-authorizations to render Telehealth services?
3. If so, is there a special modifier or service location that we need to be using on claims?
List of Insurances:
Florida Medicaid:
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT modifier and location “2” for Teletherapy
NOTE: Medicaid billing system is not currently set up to receive Teletherapy claims; FL Medicaid is aware of the issue and working on guidance and a resolution. Until then, we will have to go through the exceptional claims process for services provided during the state of emergency by telemedicine for fee for service Medicaid patients. Instructions are here for exceptional claims process https://ahca.myflorida.com/Medicaid/Operations/assistance/providers.shtml
WellCare/Staywell/CMS:
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT modifier and location “2” for Teletherapy
Prestige Health Choice:
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT modifier and location “2” for Teletherapy
NOTE: Reach out to your provider rep to initiate a security audit for billing Telemedicine.
Miami Children’s Health Plan:
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT modifier and location “2” for Teletherapy
Vivida Health:
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT modifier and location “2” for Teletherapy
American Therapy Administrators (ATA):
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3 however, you will need to reach out to your provider rep and have your providers sign an attestation statement.
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use location “2” for Teletherapy, no other modifiers
Reference: http://ataflorida.com/pdf/Telemedicine_Guidance_Attestation__E-Vistit_MER_COMM.PDF
Humana Medicaid:
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT modifier and location “2” for Teletherapy
Sunshine Health:
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT modifier and location “2” for Teletherapy
Simply Health:
No response at this time.
Community Care Plan:
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT modifier and location “2” for Teletherapy
Medicare Part B:
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Not for Therapy as of yet
2. Can we use existing pre-authorizations to render Telehealth services? None
3. If so, is there a special modifier or service location that we need to be using on claims? Not yet
Tricare:
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT modifier and location “2” for Teletherapy
FL Blue:
Individual plans may differ on coverage and benefits limitation. Providers are encouraged to call for member benefits on a case by case basis.
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes, for in-network providers.
2. Can we use existing pre-authorizations to render Telehealth services? Plan dependent.
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT or 95 modifier and location “2” for Teletherapy for claims beginning 3/15/2020 until further notice.
NOTE: Medicare advantage, Commercial, and Federal plans are all cleared to have Telehealth services for the next 90 days. Copays for the FEP plans are to be waived. However, you can still collect copays for Medicare advantage and commercial BCBS plans.
Humana Commercial:
Individual plans may differ on coverage and benefits limitation. Providers are encouraged to call for member benefits on a case by case basis.
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT modifier and location “2” for Teletherapy
Meritain Health:
Response: Provider Relations is working with our payors to determine.
Cigna:
Response: Individual plans may differ on coverage and benefits limitation. Providers are encouraged to call for member benefits on a case by case basis.
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Virtual Physical, occupational, and speech therapy (PT/OT/ST) services will be allowed through May 31, 2020. However, only specific codes are allowed, see reference link below for codes allowed.
2. Can we use existing pre-authorizations to render Telehealth services? No Answer
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GQ modifier and location “2” for Teletherapy
Reference: https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html
United HealthCare:
Response: Individual plans may differ on coverage and benefits limitation. Providers are encouraged to call for member benefits on a case by case basis.
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? UnitedHealthcare will reimburse physical, occupational and speech therapy telehealth services provided by qualified health care professionals when rendered using interactive audio/video technology. State laws and regulations apply. Benefits will be processed in accordance with the member’s plan. This change is effective immediately for dates of service March 18 through June 18, 2020.
2. Can we use existing pre-authorizations to render Telehealth services? No Answer
3. If so, is there a special modifier or service location that we need to be using on claims? Use the 95 modifier and location “2” for Teletherapy
Reference: https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-pt-ot-st.html
Aetna:
Individual plans may differ on coverage and benefits limitation. Providers are encouraged to call for member benefits on a case by case basis.
1. Do you allow Telehealth for Occupational, Physical, and Speech Therapy? If so, which ones? Yes for all 3 when plan covers
2. Can we use existing pre-authorizations to render Telehealth services? Yes
3. If so, is there a special modifier or service location that we need to be using on claims? Use the GT modifier and location “2” for Teletherapy
We have made our best efforts to gather this information from the sources but as with any individual case, there may be certain coverage limitations that apply which fall outside the scope of our findings. We will do our best to keep this up to date as a resource for providers to reference. Please understand, this is an effort to help the community in an uncertain and changing time for the industry. If we have made any errors, feel free to reach out and clarify and we will continue to make changes as the situation evolves.
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