Telemedicine Services Payment Policy Rev 7.01.22 To 1.27.2023
Defines coverage, billing, documentation, coding, limitations, exclusions, and temporary allowances for telemedicine/telephone (audio-only) services across Medicaid (excluding EFP), INTEGRITY, and Commercial lines for Neighborhood Health Plan of Rhode Island. Part 1 includes policy statements, prerequisites, coverage requirements, preventive medicine guidance, exclusions, provider types excluded, claim submission, documentation, reimbursement, member cost-sharing, and coding guidance including a large temporary telemedicine code grid through 12/31/2023.
Multiple CPT codes temporarily allowed for telemedicine through 12/31/2023 (marked 'Temporarily allowed by Neighborhood through 12/31/2023 = X').
Numerous codes marked Permanent = X indicating ongoing permanent allowance for telemedicine/audio-only.
Updated coding section to clarify requirements, added Doula service CPTs to Coding Grid and allowed Established E/M codes for Audio Only for PCPs effective 7/1/22.
Combined Telemedicine and Temporary Telemedicine policies and updated language/coding to align with CMS, EOHHS, OHIC guidance.
Policy update to include new POS 10 per CMS effective 4/1/22.
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