Note: These tables are informational, not advisory. The AAFP recommends that physicians verify each payer's policy and ask patients to verify their coverage ahead of appointments.
Aetna | Anthem* | Cigna | Humana |
UHC |
Medicare* | |
---|---|---|---|---|---|---|
CPT Codes: 99201-99205, 99211-99215 | ||||||
Place of Service (POS) |
Commercial: 02 Medicare Advantage: Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office) |
Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office) |
Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office) |
Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office) |
Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office) |
|
Modifier |
Commercial: -GT or -95 Medicare Advantage: -95 |
-GQ, -GT, or -95 (all three accepted) -CS *Must use appropriate ICD-10 code (Z03.818 or Z20.828 |
-95 -CS |
-95 |
95 -CS |
|
Cost-share waiver |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Covers cost-share |
Yes |
Yes |
Yes |
Yes |
Yes |
*Anthem's policies vary by state; contact your provider-relations representative.
*Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. Audio-only encounters may be billed using the appropriate Telephone Evaluation and Management code.
Aetna | Anthem* | Cigna | Humana |
UHC |
Medicare* | |
---|---|---|---|---|---|---|
CPT Codes: 99201-99205, 99211-99215 | ||||||
Place of Service (POS) |
Commercial: 02 Medicare Advantage: Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office) |
|
Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office) |
Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office) |
Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office) |
Use POS that would have been used if the service had been provided in person (e.g., POS 11 – Office) |
Modifier |
Commercial: -GT or -95 Medicare Advantage: -95 |
|
-GQ, -GT, or -95 (all three accepted)
|
-95
|
-95 |
-95 |
Cost-share waiver |
Yes (in-network physicians only) |
|
No |
Yes (in-network physicians only) |
Yes (in-network physicians only) |
Optional |
Covers cost-share |
Yes |
|
n/a |
Yes |
Yes |
No |
*Anthem's policies vary by state; contact your provider-relations representative.
**Medicare and UHC Medicare Advantage require audio-video for office visit (CPT 99201-99215) telehealth services. Audio-only encounters may be billed using the appropriate Telephone Evaluation and Management code.
A full list of Medicare telehealth services is available here. Private payers vary on covered telehealth services. Check with your provider relations representatives for each payer’s telehealth policy and covered telehealth services.
Telehealth services can be provided to new and established patients via smartphone if the smartphone allows for audio-video interaction between the physician and patient.
Originating site restrictions have been lifted. Telehealth services can be provided to all patients regardless of originating site, including patients at home.
Office visits provided via telehealth will be paid at the same rate as in-person visits when the appropriate POS is used. Practices should use the POS they would have used if the service had been provided in-person. Claims with “POS 02 – Telehealth” may be paid at a lower rate.
Medicare and most national payers will pay the full contracted/allowed amount when cost-sharing is waived. The “CS” modifier is required to trigger full payment of the allowed amount. Claims missing the “CS” modifier may not be paid at the full allowed amount.
COVID-related services include:
COVID-19-related services should be assigned the appropriate COVID-19 ICD-10 diagnosis code. Coding guidance can be found on the CDC website. Cost-sharing waivers may not be applied to claims that do not include an appropriate COVID-19 ICD-10 diagnosis code.
Some payers are allowing practices to provide telehealth office visits to provide using audio-video or audio-only communications. These visits should be coded as a typical telehealth visit as outlined above.
CMS has updated the documentation requirements for outpatient E/M services delivered via telehealth.
If exchanged asynchronously, videos, images and communications must be stored and retained according to state regulation.
Real-time (synchronous) videos, such as during a video visit or video phone call, are not required to be stored.
Self-funded plans can develop their own policies and may opt out of some cost-sharing waivers. Similarly, Medicaid policies are established at the state level. The AAFP recommends reaching out to your provider relations representatives or Medicare Administrative Contractors (MACs) to verify policies. The Center for Connected Health Policy is tracking COVID-19 Related State Actions
The Medicare AWV codes (HCPCS codes G0438 and G0439) are on the list of approved Medicare telemedicine services. CMS states that self-reported vitals may be used when a beneficiary is at home and has access to the types of equipment they would need to self-report vitals. The visit must also meet all other requirements.
Commercial and private payers may have different policies. Please check with your provider relations representatives for additional guidance.
CMS has released guidance allowing federally qualified health centers (FQHCs) and rural health clinics (RHCs) to provide distant-site telehealth services. Telehealth services can be provided by any practitioner working for the FQHC or RHC within their scope of service, and there are no restrictions on where the service is provided, meaning physicians or practitioners may provide the service from their homes.
The payment rate for telehealth services furnished by an FQHC or RHC practitioner is $92. FQHCs and RHCs must use the -95 modifier for distant-site services provided between Jan. 27 and June 30, 2020. FQHCs will be paid their Prospective Payment System (PPS) rate, and RHCs will receive their all-inclusive rate (AIR). Claims will be automatically reprocessed in July, when the Medicare claims processing system is updated with the new rate.
For distant-site services provided between July 1, 2020, and the end of the COVID-19 public health emergency, FQHCs and RHCs should use HCPCS code G2025 to identify the services furnished via telehealth.
CMS is waiving cost-sharing for services related to COVID-19 testing, FQHCs and RHCs should append the -CS modifier to claims related to COVID-19 testing. Coinsurance should not be collected from beneficiaries when cost-sharing is waived. MACs will automatically reprocess these claims beginning on July 1.