COVID-19 Insurance Updates

This is the latest information by the insurance companies as of today, interpreted by HIS. We will be reviewing insurance carrier websites 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- June 4, 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.

Reference: https://www.aetna.com/health-care-professionals/provider-education-manuals/covid-faq.html#acc_link_content_section_responsivegrid_copy__responsivegrid_accordion_10 

Reference: https://www.aetna.com/health-care-professionals/newsletters-news/office-link-updates-december-2019/news-for-you-december-2019/updated-policy-for-telemedicine.html

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- June 15, 2020
  • Covering telephone only services from March 19, 2020- June 17,2020
  • 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)

 

Reference: Indiana: https://providernews.anthem.com/indiana/article/information-from-anthem-for-care-providers-about-covid-19-updated-march-19-2020-3

Wisconsin: https://providernews.anthem.com/wisconsin/article/information-from-anthem-for-care-providers-about-covid-19-updated-march-19-2020-3

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 until the end of the PHE will be covered.
  • 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: https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/Cigna-COVID-19-Billing-Guidiance-for-Providers-3-18.PDF

Reference:

https://cignaforhcp.cigna.com/web/secure/chcp/resources/!ut/p/z1/jZDBbsIwEES_hUOOrdeRockxCSS4oTJtIBBfkElNsAROZIdW7dfXRVV7Arq3nXkj7SziaI24Fm-qEb1qtTi4veKjzTwplzgPCbD0eQIUR2RB2BAgwGh1BrJg6GcxwVmQU-IA9phHZeoDAOL_yV8BvvNwYSJAlcs_bFgWjPC0gClAmAINi3ju0ydHYFQgjriRO1R5YFUvrQf1vu48MNK2J1PLmdoaYT48OMpXVYvDy49uZ8r2v-q4VbqJT1Zpae1K9ftENVr82dv3OmElHd_h8L4TjXTF-Pn2a6-5Va47Ltefi103iQaDL0zYvio!/dz/d5/L2dBISEvZ0FBIS9nQSEh/

Reference:

https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html?elqTrackId=8eaa70d147644cf592810b2bafec1359&elq=a2dd560d769046688b9eeb179ff9a413&elqaid=23551&elqat=1&elqCampaignId=21997

April 9, 2020

https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html

 

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

 

Reference: https://www.bcbsil.com/provider/education/2020/2020_03_16.html

 

Florida Blue

  • Effective from March 17, 2020 until June 15, 2020
  • CPT codes 99201-99215- require audio and visual communication for established patients, with E/M documentation requirements
  • 99441-99443 (added 4/9/20)
  • 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/sites/floridablue.com/files/docs/COVID-

19_Update%20as%20of%20March%202020_100562%200220_03.17.20_v11_APPROVED--.pdf

 

Reference: https://www.floridablue.com/providers/covid-19-information

 

Reference: April 9, 2020 update: https://www.floridablue.com/sites/floridablue.com/files/docs/COVID-19%20Billing%20Guidelines_04.09.20_Approved.pdf

 

Reference April 22, 2020- https://www.floridablue.com/sites/floridablue.com/files/docs/COVID-

19%20Billing%20Guidelines_04.22.20_v5_Approved.pdf

 

Florida Blue Therapy Services (updated 4/8/2020)(updated 4/9/20)

  • Effective March 15, 2020 until further notice
  • Place of service 02 for commercial claims, place of service 11 for Medicare Advantage claims
  • Modifier 95 or GT
  • No procedure codes are listed
  • 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- June 8, 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-June 8, 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.

 

Reference: https://s3.amazonaws.com/iuhealthplans/page-content/IU-Health-Plans-Coverage-and-Payment-Related-During-COVID_EMergency-2020.04.01.pdf?mtime=20200401123337

 

Medicare

  • 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 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 95 https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/news-alerts/news-articles/news-detail/modifier%2095%20as%20it%20relates%20to%20medicare%20part%20b%20and%20covid-19%20billing/!ut/p/z1/1VLbUoMwEP2V9gOYTbgVHsPF0lKk6CCGF4YhUKNcKtR29OsNTsd6mdpn87Kz2XNO9mwWUriHtM33fJPveNfmtchpqmcqWbgY28gPDQ8h4jtEJddzxYgx3AG1gLrP0QOKILmETkUZnTkECX76ATkpKKGBiHplOU60VuaWfAT8oUFFD7OzPWAMyZ6XB4jbrm-EwdtRMbGDLIrdG8FtN8MqFI7Web-biLgKbaCLuuZtx4dj-dvN40vPB8aLcWBAl1-yiT7ST1rioW3BGVDNlJUZKpmksbyS1MLQpdzUmWTKGCOksgqZJXgXrSj_xcryx6f-WovE_lyhFMO2aV-

lpypwD4R4TeZYASGWtn_zyXT6DoJI7yY!/dz/d5/L2dBISEvZ0FBIS9nQSEh/?ngsLOB=Part%20B&LOC=Illinois&ngsLOC=Illinois&jurisdiction=Jurisdiction%206&LOB=Part%20B

 

Reference: Update 4/21/2020 Modifier CR https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-

lob/news-alerts/news-articles/news-detail/modifier%20cr%20as%20it%20relates%20to%20medicare%20part%20b%20and%20covid-19%20billing/!ut/p/z1/1VLbUsIwEP0V-

IDOZm2K5TG9SKHUUp1a05dOL4DRXrBFGP16U4cRL4M8m5edzZ5zsmezEMM9xHW6E-

t0K5o6LWXO41FC2dRGNInr6w4hzLUYZdcTVQ8R7oBbwO3n4IEEEJ1Dx7JMThxGJD_-gBwVVF8njF4ZlhUs1IlxcQD8ocFlD5cne0CEaCeWewjrpq2kwdteMTK9JAjtG8mt193cN4Av0nY7kHHum8CnZSnqRnSH8rebx5dWdIXI-4EBn33JBqOeftSSD21yUQDHrKBLOtYUpJmuUERNGat5rqRUx4ygukIswDlrRf0vVmY_PvXXWkT25wrFCJuqflWeVp69Z8ypEsvwGDO03ZvLhsN3wSbJVw!!/dz/d5/L2dBISEvZ0FBIS9nQSEh/?ngsLOB=Part%20B&LOC=Illinois&ngsLOC=Illinois&jurisdicti

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

 

Medicare Therapy Services

Updated April 30, 2020

Updated April 3, 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 June 18, 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 June 18, 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)

 

Reference: Provider Telehealth Policies:https://www.uhcprovider.com/en/resource-library/news/provider-telehealth-policies.html

 

Telehealth and Telemedicine Policy:

https://www.uhcprovider.com/content/provider/en/viewer.html?file=https%3A%2F%2Fwww.uhcprovider.com%2Fcontent%2Fdam%2Fprovider%2Fdocs%2Fpublic%2Fpolicies%2Fcomm-reimbursement%2FCOMM-Telehealth-and-Telemedicine-Policy.pdf

 

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

 

https://www.uhcprovider.com/content/provider/en/viewer.html?file=%2Fcontent%2Fdam%2Fprovider%2Fdocs%2Fpublic%2Fresources%2Fnews%2F2020%2FCOVID19-Telehealth-Services-PT-OT-ST.pdf

 

April 3, 2020 Update:

https://www.uhcprovider.com/content/provider/en/viewer.html?file=%2Fcontent%2Fdam%2Fprovider%2Fdocs%2Fpub

lic%2Fresources%2Fnews%2F2020%2FTelehealth-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

 

Reference: April 24, 2020

https://www2.illinois.gov/sites/iwcc/resources/Documents/COVID19_MEDICAL_FEE_SCHEDULE.pdf