CurrentAnthemPolicy C-08002

Virtual Visits - Professional and Facility

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Defines Anthem's reimbursement rules for professional and facility virtual visits (telehealth, audio-only, asynchronous, store-and-forward, and remote patient monitoring) and who may bill for them; applies to providers and facilities submitting claims to the health plan.

Policy Summary

PayerAnthem

PolicyVirtual Visits - Professional and Facility

Policy CodePolicy C-08002

Change TypeMaterial operational updates

Effective DateJul 1, 2026

Last ReviewApr 1, 2026

Next Review DateN/A

Key ActionSubmit professional virtual visit claims with office place-of-service coding and required modifiers (95/GT for audio-video; 93/FQ for audio-only; GQ for asynchronous) and appropriate CPT/HCPCS codes.

SourceLink

POLICY UPDATE CHANGES

All virtual visits performed by professional providers will be subject to office reimbursement.

Professional audio-only and asynchronous services were added as reimbursable.

Facility telehealth reimbursement is limited to behavioral health services for live audio-video; originating site fees are allowed for facility providers only.

Facility virtual visits via live audio-video for non-behavioral health and facility audio-only visits are nonreimbursable.

Professional: allowedprofessional virtual visits reimbursable

Behavioral health onlyfacility live audio-video reimbursable scope

Q3014facility originating site fee allowed

93, FQaudio-only professional

GQasynchronous modifier

Coverage Criteria for Virtual Visits

Place of Service, Modifiers, and Facility Coding

Place of Service (telehealth)mixedCovered

02	Place of service indicating telehealth
10	Place of service indicating telehealth

Synchronous audio-video modifiersModifierCovered

95	Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System
GT	Via interactive audio and video telecommunication systems

Synchronous audio-only modifiersModifierCovered

93	Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
FQ	The service was furnished using audio-only communication technology (applies to audio-only Behavioral Health Services)

Asynchronous modifierModifierCovered

GQ	Via asynchronous telecommunications system (required when no Telehealth/Telemedicine specific code has been reported)

Originating site facility feeHCPCSCovered

Q3014

Telehealth originating site fee (facility providers only; member must be physically present in the originating facility)

Facility scope

Facility live audio-video scopeFacility live audio-video visits reimbursed only for Behavioral Health services

Originating site feeOriginating site fee (Q3014) allowed only for facility providers

Facility claim requirementsFacility claims must include the appropriate revenue code, CPT/HCPCS code, and telehealth modifier

Professional distant-site reimbursementProfessional virtual visits rendered at the distant site are reimbursable when conducted via secure/private connection and are eligible for office place-of-service reimbursement

Place of service codesUse telehealth place-of-service coding (e.g., 02 or 10) as applicable for virtual visit billing

Authorization, Documentation, and Billing Requirements

Prior Authorization

Obtain authorizations and meet medical necessity; follow mandates

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis and to the member's state of residence; follow applicable provider, state, federal or CMS mandates which may supersede this policy. Use proper billing and submission guidelines and industry-standard, compliant CPT, HCPCS and/or revenue codes; services billed must be fully supported in the medical record and/or office notes. Failure to follow coding/billing or authorization requirements may result in claim rejection, denial, recovery or recoupment.

Verify prior authorization and medical necessity per member benefit and state requirements before providing virtual visit services.
Bill with appropriate CPT/HCPCS and/or revenue codes and ensure documentation in the medical record supports billed services.
Be aware that provider, state, federal or CMS mandates may override this policy.

Definitions

Asynchronous

DefinitionAsynchronous telehealth occurs over time with a delay between contributions; interaction occurs independently of time (also known as store-and-forward).

Alternate nameStore-and-forward.

Use case noteUsed for member-to-provider or provider-to-provider communications where real-time interaction is not required.

Distant Site

DefinitionDistant site: the site where the physician or practitioner providing the professional service is located at the time the service is provided via a telecommunications system.

Reimbursement contextVirtual visits rendered at the distant site by professional providers are reimbursable when delivered through secure and private connections.

Billing noteProfessional claims for distant-site services are eligible for office place of service reimbursement and must meet submission criteria.

Originating Site

DefinitionOriginating site: the location of the member at the time the service is furnished via a telecommunications system.

Originating site feeAn originating site facility fee (HCPCS Q3014) may be billed by facility providers when applicable.

Place of serviceWhen billing for originating site-related services, use the appropriate place of service code for the in-person provider rendering services to the member.

Remote Patient Monitoring / Remote Physiologic Monitoring

DefinitionRemote Patient Monitoring / Remote Physiologic Monitoring: treatment management services provided by medical professionals to manage a patient under a specific treatment plan via live interactive communication or store-and-forward through a medical device defined by the FDA and ordered by a physician or other qualified health care professional.

ModalityCan be delivered via live interactive communication or store-and-forward using FDA-defined devices.

Billing contextBilled with the place of service appropriate to the location of the billing provider and the applicable CPT/HCPCS codes.

Synchronous

DefinitionSynchronous telehealth occurs when real-time technology allows the patient or client to interact with a practitioner using a telephone or video connection, or a combination of both.

Also known asReal-time audio and/or video interaction between patient and practitioner.

Modifier/PO S noteUse applicable telehealth modifiers and place of service codes as required for synchronous services.

Telehealth/Telemedicine

DefinitionTelehealth/Telemedicine: the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and the physician or practitioner at the distant site.

ScopeIncludes synchronous audio-video services; professional virtual visits delivered via telehealth must use secure/private connections.

Coding noteProfessional virtual visit claims should be submitted with the appropriate telehealth place of service and modifiers per policy guidance.

Virtual Visits

DefinitionVirtual Visits: technology-based services including telehealth/telemedicine services, e-visits, virtual check-ins, telephone visits, and remote patient monitoring.

InclusionsEncompasses synchronous telehealth, asynchronous/store-and-forward, audio-only (telephone) visits, and RPM modalities.

Reimbursement noteProfessional virtual visits rendered at the distant site are reimbursable when delivered through secure/private connections and billed per policy requirements.

Policy Summary

PayerAnthem

PolicyVirtual Visits - Professional and Facility

Policy CodePolicy C-08002

Change TypeMaterial operational updates

Effective DateJul 1, 2026

Last ReviewApr 1, 2026

Next Review DateN/A

SourceLink

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Virtual Visits - Professional and Facility

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Place of Service, Modifiers, and Facility Coding

Place of Service (telehealth)mixedCovered

02	Place of service indicating telehealth
10	Place of service indicating telehealth

Synchronous audio-video modifiersModifierCovered

95	Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System
GT	Via interactive audio and video telecommunication systems

Synchronous audio-only modifiersModifierCovered

93	Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
FQ	The service was furnished using audio-only communication technology (applies to audio-only Behavioral Health Services)

Asynchronous modifierModifierCovered

GQ	Via asynchronous telecommunications system (required when no Telehealth/Telemedicine specific code has been reported)

Originating site facility feeHCPCSCovered

Q3014

Telehealth originating site fee (facility providers only; member must be physically present in the originating facility)

Facility scope

Facility live audio-video scopeFacility live audio-video visits reimbursed only for Behavioral Health services

Originating site feeOriginating site fee (Q3014) allowed only for facility providers

Facility claim requirementsFacility claims must include the appropriate revenue code, CPT/HCPCS code, and telehealth modifier

Place of service codesUse telehealth place-of-service coding (e.g., 02 or 10) as applicable for virtual visit billing

Authorization, Documentation, and Billing Requirements

Prior Authorization

Obtain authorizations and meet medical necessity; follow mandates

Verify prior authorization and medical necessity per member benefit and state requirements before providing virtual visit services.
Bill with appropriate CPT/HCPCS and/or revenue codes and ensure documentation in the medical record supports billed services.
Be aware that provider, state, federal or CMS mandates may override this policy.

Definitions

Asynchronous

DefinitionAsynchronous telehealth occurs over time with a delay between contributions; interaction occurs independently of time (also known as store-and-forward).

Alternate nameStore-and-forward.

Use case noteUsed for member-to-provider or provider-to-provider communications where real-time interaction is not required.

Distant Site

DefinitionDistant site: the site where the physician or practitioner providing the professional service is located at the time the service is provided via a telecommunications system.

Reimbursement contextVirtual visits rendered at the distant site by professional providers are reimbursable when delivered through secure and private connections.

Billing noteProfessional claims for distant-site services are eligible for office place of service reimbursement and must meet submission criteria.

Originating Site

DefinitionOriginating site: the location of the member at the time the service is furnished via a telecommunications system.

Originating site feeAn originating site facility fee (HCPCS Q3014) may be billed by facility providers when applicable.

Place of serviceWhen billing for originating site-related services, use the appropriate place of service code for the in-person provider rendering services to the member.

Remote Patient Monitoring / Remote Physiologic Monitoring

ModalityCan be delivered via live interactive communication or store-and-forward using FDA-defined devices.

Billing contextBilled with the place of service appropriate to the location of the billing provider and the applicable CPT/HCPCS codes.

Synchronous

DefinitionSynchronous telehealth occurs when real-time technology allows the patient or client to interact with a practitioner using a telephone or video connection, or a combination of both.

Also known asReal-time audio and/or video interaction between patient and practitioner.

Modifier/PO S noteUse applicable telehealth modifiers and place of service codes as required for synchronous services.

Telehealth/Telemedicine

ScopeIncludes synchronous audio-video services; professional virtual visits delivered via telehealth must use secure/private connections.

Coding noteProfessional virtual visit claims should be submitted with the appropriate telehealth place of service and modifiers per policy guidance.

Virtual Visits

DefinitionVirtual Visits: technology-based services including telehealth/telemedicine services, e-visits, virtual check-ins, telephone visits, and remote patient monitoring.

InclusionsEncompasses synchronous telehealth, asynchronous/store-and-forward, audio-only (telephone) visits, and RPM modalities.

Reimbursement noteProfessional virtual visits rendered at the distant site are reimbursable when delivered through secure/private connections and billed per policy requirements.