Telehealth Coding and Billing Tips: Updates and Guidance for COVID-19

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As Axea continues to closely monitor the impact of legislative responses to the COVID-19 Public Health Emergency, we are providing partners with updates and guidance on how to manage best practices and navigate the process.
Here are some quick reference tools and valuable resources on telehealth services.

RECENT UPDATE: March 20, 2020: Telehealth Waiver Provisions:
​Update:
Revised the article to add a note in the Telehealth section to cover the use of modifiers on telehealth claims and to explain the DR condition code is not needed on telehealth claims under the waiver. All other information remains the same.

​​The Center for Disease Control (CDC) is encouraging communities, including 1st responders, healthcare “providers,” and health systems to offer telehealth during the COVID-19 crisis. The Centers for Medicare & Medicaid Services (CMS) lifted Medicare restrictions on the use of telehealth services during the COVID-19 emergency. As a result of the current public health emergency waivers and modifications were authorized under Section 1135 of the Social Security Act (the Act).

Expansions for Telehealth under the 1135 waiver include the below
Key Changes:   

• Effective March 6 and throughout the national public health emergency, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19.
• Patients can receive telehealth services in all areas of the country and in all settings, including at their home. 
• CMS will not enforce a requirement that patients have an established relationship with the physician providing telehealth.
• Physicians can reduce or waive cost-sharing for telehealth visits.
• Physicians licensed in one state can provide services to Medicare beneficiaries in another state. State licensure laws still apply.

Overview
 
There are three main types of virtual services physicians and other professionals can provide to Medicare beneficiaries: 

• Telehealth visits
• Virtual check-ins
• E-visits

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Summary or Medicare Services:

 A list of all available codes for telehealth services can be found on the CMS website, follow link here: Telehealth Codes

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Payer Policies

The federal government is requesting private payers to cover telehealth for COVID-19 as a way to minimize the spread of the virus in the community and clinical settings. This COVID-19 resource from the Center for Connected Health Policy (CCHP) provides an up to date summary of telehealth rules, including state licensure and private payer policies regarding telehealth coverage.
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Access telehealth rules detail here: Telehealth Rules

Please note that changes in payer policies are changing from day to day, so be sure and check the policies of your most common payers!


Quick Resources

Access the links below for more detailed information:

CMS fact sheet
CMS FAQ’s
Medicaid coverage
COVID-19 Task Force 
Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit
Informational fact sheet on the accelerated/advance payment process and how to submit a request 



Axea Solutions telehealth experts are available for support as additional legislative changes continue to evolve. For more information, please contact an Axea representative.

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