Telehealth Policy (COVID-19)
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Telehealth Policy (COVID-19)

Children's Community Health Plan Telehealth Policy in Response to COVID-19

Children’s Community Health Plan is expanding our coverage and policies related to telehealth services for our Medicaid and Marketplace/Commercial members in response to the COVID-19 outbreak.  

Our goal is to make it easier and safer for patients to connect with their health care provider. Telehealth/telemedicine services may include consultations, office visits, individual psychotherapy and pharmacologic management delivered via a telecommunications system such as FaceTime, Skype, Zoom or any other face to face technology.

For telehealth services, CCHP is waiving the originating site requirement and allowing services to be provided regardless of the member location. This will allow providers to bill telehealth services for patients that are at home or another location. This change allows patients to connect with their physician through an audio and video visit.

CCHP will reimburse telehealth services that are recognized by CMS and billed with modifiers GT or 95 for synchronous (real-time) teleheath services, or GQ for asynchronous services. For our Commercial/Marketplace members, please be aware that cost sharing may apply unless the service is related to COVID-19 testing.

 

Telephone, Virtual Check-In and E-visits

CCHP will also cover telephonic check-in which will allow patients to connect with their doctors without video. These services are for established patients, not related to a medical visit within the previous 7 days and not resulting in a medical visit within the next 24 hours (or soonest appointment available).

These services can be billed when furnished through several communication technology modalities, such as telephone (HCPCS code G2012) or captured video or image (HCPCS code G2010).

CCHP will also reimburse for patients to communicate with their doctors using virtual visits through in-network healthcare system online tools. The appropriate CPT codes (99421-99423) and HCPCS codes (G2061-G2063) should be used, as applicable. E-consults between the primary care provider and specialty care provider can also be billed using CPT codes 99451 and 99452.

CCHP is using the CMS Medicare Telemedicine Health Care Provider Fact Sheet for our expanded telemedicine coverage guidance.

These policy changes will be effective until May 30, 2020. CCHP may extend the date if necessary and will communicate any changes.

We request that providers do not submit telemedicine claims until April 1, 2020, to allow us time to update our administrative systems.

Thank you again for your continued care of our members.

 

Telehealth FAQ

CCHP’s definitions of telehealth, virtual check-ins and e-visits align with the current CMS Medicare Telemedicine Health Care Provider Fact Sheet.

*Please note that the CCHP Medicaid product and the Together with CCHP product will allow telehealth, virtual check-ins, e-visits and telephone-only services as outlined below.

 

CCHP is temporarily providing this coverage until May 30, 2020, recognizing the need to support continuity of care for Plan members during extended periods of social distancing. For billing guidelines please reference the Forward Health Updates:

 

ForwardHealth Allowable Services via Telehealth

*Keep in mind that cost sharing may apply for the Together with CCHP members for services not related to COVID-19 testing.

 

A quick overview:

What is telehealth, does CCHP cover it, and how do I bill for it?

  • Telehealth is a visit with a provider that uses telecommunication systems between a provider and a patient. This can include Skype, Zoom, FaceTime or any other face-to-face technology.
  • CCHP will reimburse providers for telehealth services. CCHP is waiving the originating site requirement and allowing services to be provided regardless of the member location. This allows providers to bill telehealth services for patients that are at home or another location. This change allows patients to connect with their physician through an audio and video visit.
  • CCHP will reimburse telehealth services that are recognized by CMS and billed with modifiers GT or 95 for synchronous (real-time) teleheath services, or GQ for asynchronous services. Telehealth should be billed with Place of Service (POS) 02. For our Commercial/Marketplace members, please be aware that cost sharing may apply unless the service is related to COVID-19 testing.
  • A provider can bill CPT codes that they would use if they were seeing the member in the office for the same service. Appropriate modifiers and (POS) 02 must be billed to reference the claim is for telehealth.
  • Please reference the Forward Health Updates for more information on how to bill for telehealth services.
  • CCHP is temporarily waiving the requirement that the in-network provider’s telehealth program be credentialed.

 

What is a virtual check-in, does CCHP cover it and how do I bill for it?

  • A virtual check-in is a brief (5-10 minute) check-in with a practitioner via telephone or other telecommunication device to decide whether an office visit or other service is needed. It can include a remote evaluation of recorded video and/or images submitted by an established patient.
  • As a result of the COVID-19 public health emergency, CCHP is temporarily covering virtual check-ins until May 30, 2020, recognizing the need to support continuity of care for Plan members during extended periods of social distancing.
  • Virtual check-ins can be billed using HCPCS G2010 and G2012.

           

What is an e-visit, does CCHP cover it and how do I bill for it?

  • An e-visit is a communication between a patient and their provider through an online patient portal.  
  • As a result of the COVID-19 public health emergency, CCHP is temporarily covering e-visits until May 30, 2020, recognizing the need to support continuity of care for Plan members during extended periods of social distancing. 
  • Please reference the Forward Health Updates on how to bill for e-visits.

 

What is telephone-only services, does CCHP cover it, and how do I bill for it?           

  • Telephone-only services is a telephone call between the member and provider when technology for telehealth or e-visits is not available.
  • As a result of the COVID-19 public health emergency, CCHP is temporarily covering telephone-only visits when telehealth via audio and video is not available. CCHP is temporarily providing this coverage until May 30, 2020, recognizing the need to support continuity of care for Plan members during extended periods of social distancing. 
  • Please reference the Forward Health Updates on how to bill for telephone only services.

 

What services can be provided via telehealth, e-visits or by telephone?

Any office or urgent care visit that can be provided face-to-face can now be provided through telehealth, e-visit or by phone. This also includes visits for behavioral health and substance abuse, day treatment and intensive outpatient, as well as Physical, Occupational and Speech therapy. For information on how to bill for these services please reference the Forward Health Updates.

 

Will previously approved authorizations for elective procedures/surgeries be extended?

Yes, CCHP is extending all outstanding prior authorizations for 90 days.

 

Will CCHP waive cost sharing for COVID-19 testing and related services?

Children’s Community Health Plan will cover and waive all member cost sharing, including copays, coinsurance, and deductibles, for COVID-19 diagnostic testing, related office visits, urgent care and/or emergency room visits to establish the diagnosis of COVID-19 when performed at participating provider locations or laboratories.

 

What HCPCS codes are used for laboratory testing?

CMS created the following HCPCS codes for laboratory testing. The codes below should be used when billing for COVID-19 testing:

  • HCPCS U0001
    • This code is used for the laboratory test developed by the CDC
  • HCPCS U0002
    • This code is used for the laboratory test developed by entities other than the CDC

 

What diagnosis codes should be billed for COVID-19 services?

The CDC has provided interim coding guidance on which ICD-10 diagnosis codes to report. View the CDC Interim Code Guidelines or visit the CDC website for more information.

 

Additional Resources for Telehealth

 

 

 

Medicaid

Children's Community Health Plan

PO Box 56099
Madison, WI 53705
1-800-482-8010

Together with CCHP

Children's Community Health Plan

PO Box 1997, MS 6280
Milwaukee, WI 53201
1-844-201-4672

 

National Committee for Quality Assurance (NCQA) Accreditation

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