Telehealth tip sheet (COVID-19)
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Guidance for Simply Healthcare Plans, Clear Health Alliance, and Florida Healthy Kids (and Simply Medicare Advantage) on telehealth coding, billing, and reimbursement during the COVID-19 public health emergency; applies to providers furnishing telehealth to members under Medicaid, Medicare Advantage, and Florida Healthy Kids programs.
No material clinical or coverage changes in this revision.
Telehealth Coverage During the COVID-19 PHE
Coverage criteria during COVID-19 PHE
Telehealth services are covered for eligible programs during the COVID-19 public health emergency (PHE) with modality- and code-specific guidance. Coverage differs by program (Medicare, Medicaid/SMMC MMA/FHK) and by payment arrangement (capitated vs FFS).
Billing Codes and Reimbursement Rules
| 99201-99215 | Office or other outpatient visits (common telehealth services) |
| G0425-G0427 | Telehealth consultations, ED or initial inpatient |
| G0406-G0408 | Follow-up inpatient telehealth consultations |
| G2012 | Virtual check-in |
| G2010 | Remote evaluation of recorded video/images (store-and-forward) |
Provider Billing and Submission Requirements
Submit encounters/claims and modifier requirement
Capitated providers should submit encounters for telehealth services as they normally do; telehealth services are considered inclusive to the provider’s contractual capitation. Fee-for-service providers must submit claims using the appropriate telehealth billing codes and, for Medicaid/FFS, append the GT modifier to the procedure code.
- Capitated providers: submit encounters for services rendered via telehealth according to guidance; telehealth is included in contractual capitation.
- FFS providers: submit claims with appropriate telehealth billing codes; append GT modifier in the fee-for-service delivery system for Medicaid.
Medicare billing guidance during PHE
For Medicare FFS during the COVID-19 PHE, bill telehealth services using the appropriate CPT/HCPCS codes (for example, 99201-99215, G0425-G0427, G0406-G0408, G2012, G2010) and append modifier 95 where indicated. For many nontraditional telehealth services with dates of service on or after March 1, 2020, bill the Place of Service (POS) equal to what it would have been in the absence of the PHE.
- Use modifier 95 for telehealth visits and virtual check-ins where indicated.
- Bill POS as it would have been absent the PHE for nontraditional telehealth services furnished during the PHE (dates on or after March 1, 2020).
Telehealth Waiver and Modality Definitions
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