CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Temporary expansion of preventive telemedicine services reimbursement

Temporary policy governing reimbursement and billing for preventive medicine and annual wellness visits provided via telemedicine or telephone-only to Neighborhood participating providers across Medicaid, INTEGRITY, and Commercial lines.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyTemporary expansion of preventive telemedicine services reimbursement

Policy CodePolicy N/A

Change TypeClarification of effective period

Effective DateMar 18, 2020

Next Review DateN/A

Key ActionSubmit the preventive E&M or AWV claim on the telemedicine/telephone encounter date using the office-equivalent E&M CPT code with POS 02 and retain documentation linking any subsequent in-person visit.

SourceLink

POLICY UPDATE CHANGES

Policy effective date and duration updated to reflect extensions of the Executive Order through early August 2020.

100%reimbursement of preventive telemedicine/telephone E&M at in-office allowable amount

Until 08/02/2020expected temporary policy end date

0member cost share for preventive services

Multiplepreventive codes covered via telemedicine/telephone

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Coverage Criteria for Preventive Telemedicine/Telephone Services

Coverage Criteria — Preventive Telemedicine/Telephone Services

Covered preventive services and limits during the temporary policy period. Services below are covered when delivered via telemedicine or telephone only as noted; certain services remain excluded or require in-person delivery.

ALL of the following

Adult Annual Preventive Exams are covered when delivered via telemedicine or telephone during the temporary policy period.
Pediatric Preventive (Well Child) Exams are covered. For children age 24 months and under, and for children over 24 months in need of vaccination, in-person well child visits are recommended to ensure critical immunizations and screenings are administered at the appropriate age.
For children over 24 months of age, or children under 24 months who cannot be seen in person, well child visits may be conducted using telemedicine or telephone modalities consistent with this policy. Remaining elements of the visit should be completed in person as soon as community circumstances allow.
Operational note: prioritize in-person care for vaccinations and age-based screenings when feasible.
Annual Wellness Visit (AWV) is covered for INTEGRITY members when delivered via telemedicine or telephone in accordance with this policy.
No member cost sharing applies to any preventive service delivered under this policy during the temporary policy period.
Member responsibility: $0 cost share for preventive services.
Exclusion: The policy does not apply to the Medicare 'Welcome to Medicare' initial preventive physical examination (HCPCS G0402). That visit must be face-to-face and is not covered via telemedicine or telephone under this policy.
Billing/coverage restriction: HCPCS G0402 requires in-person visit.

Billing and Codes Permitted via Telemedicine/Telephone

Preventive E&M and AWV codes allowed via telemedicine/telephoneCPT | HCPCSCovered

99381-99387	Initial comprehensive preventive medicine E&M (new patients) codes by age group
99391-99397	Periodic comprehensive preventive medicine E&M (established patients) codes by age group
G0438	Annual wellness visit; initial
G0439	Annual wellness visit; subsequent

Single billing requirement

RequirementPreventive E&M or AWV CPT/HCPCS code must be submitted only once, on the initial telemedicine/telephone date of service and reported with place of service (POS) 02 (Telehealth).

Subsequent in-person billingServices performed during the later face-to-face visit (physical components) must be billed separately on the later date using appropriate procedure codes and POS 11 (office) or other appropriate POS.

Coding to use on telemedicine/telephone dateSubmit the office-equivalent preventive E&M CPT code that would have been used if service provided in-office (e.g., 99381-99397 or G0438-9) on the telemedicine/telephone claim with POS 02.

Documentation linkMedical record must reflect both encounters; the face-to-face progress note must reference the date of the initial telemedicine/telephone encounter and be tied to the initial encounter in the EMR.

Claim Submission, Documentation, and Audit

Documentation Required

Claim submission and documentation

Submit the preventive E&M or AWV CPT/HCPCS code on the date the telemedicine/telephone-only service occurs, using the office-equivalent E&M code and place of service (POS) 02; document the telemedicine/telephone components performed and link documentation to any subsequent in-person encounter.

Report the appropriate E&M procedure code that would be used if the service was provided in the office (e.g., 99381-99397 or G0438-9) on the telemedicine/telephone date of service.
Submit the claim with POS 02 (Telehealth) for the remote encounter.
Document the clinical components performed remotely and ensure the in-person progress note references the date of the initial telemedicine/telephone encounter.

Denial Risk

Audit and record retention

Neighborhood reserves the right to audit medical and administrative records to verify adherence to this policy; records may be requested to support reimbursement of preventive telemedicine/telephone services.

Definitions

Preventive telemedicine/telephone encounter definition

Definition - preventive telemedicine/telephone encounterThe portion of a preventive medicine E&M or Annual Wellness Visit (AWV) that is clinically appropriate to be performed remotely and billed using the E&M or AWV code on the date of the remote encounter (POS 02).

What to bill on remote dateReport the appropriate office-equivalent preventive E&M CPT code (e.g., 99381-99397) or AWV HCPCS (G0438/G0439) on the telemedicine/telephone date with POS 02.

PurposeAllows delivery and reimbursement of the preventive visit components that can be completed without an in-person exam during the COVID-19 temporary policy period.

Face-to-face follow-up definition

Definition - face-to-face follow-upThe subsequent in-person visit to perform physical components/requirements of the preventive exam (e.g., immunizations, vitals, screenings) billed separately on a later date with POS 11; the preventive E&M or AWV code must NOT be billed again on this visit.