Medicare and Commercial Insurances Telemedicine Billing Policies
CMS is frequently updating its policies to make telemedicine available to all its beneficiaries. However, these policies may or may not be followed by commercial insurances. As a practice, you might have several questions while providing care to patients with private insurances.
◘ Will this payor cover audio only services?
◘ Can I bill a consult code for this insurance?
◘ Do I need to use POS 02 or POS 11?
◘ Will this service get bundled as per the payor policy?
◘ What are the restrictions for billing this code?What are the modifiers to be used while billing this service?
We have been working with our clients to help them get the most out of the new telehealth rules. The following information is collated by working with insurances and closely referring to the latest updates on the insurance websites.
Note: These rules are as of May 05, 2020 and would be updated as and when changes are applicable.
► Telemedicine coverage insurance verification recommendations
To plan further and for better clarity, check online or call the insurance for the following information while checking eligibility:
◘ Is telemedicine covered for this patient plan?
◘ Are there any specific restrictions from your insurance for billing telemedicine?
◘ Will patient have to share cost for this service (co-pay, coinsurance, deductible) – Specific guidelines for getting paid 100%
◘ Does your insurance follow CMS guidelines for reimbursement?
◘ What are the services included under telehealth?
◘ Are telephonic codes reimbursed at televisit rates?
► Reimbursement parity telemedicine visit to face-to-face visit
As per the interim rule CMS announced to reimburse telehealth visit at the same rate as in person visits. Refer to the below table to check similar guidelines from commercial insurances.
► Reimbursement parity telephonic visits to real time televisit
CMS has announced payments for telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. These payments are retroactive to March 1, 2020. Refer to the below table for similar guidelines from commercial insurances.
► Cost sharing telemedicine waiver updates
► COVID-19 Testing-Related Telehealth Visits (MODIFIER CS)
The Families First Coronavirus Response Act from CMS waives cost-sharing under Medicare Part B (coinsurance and deductible amounts) for Medicare patients for COVID-19 testing-related services. These services are medical visits for the HCPCS evaluation and management categories described below when an outpatient provider, physician, or other providers and suppliers that bill Medicare for Part B services orders or administers COVID-19 lab test U0001, U0002, or 87635. This means that if a telemedicine service is provided which further results in a COVID-19 test than the cost sharing would be waived for televisit as well as COVID-19 testing.
Refer to the below table for updates from commercial insurances. We will update this list as and when updates are available from other insurances.
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