COVID-19 Telemedicine Payer Information

This page includes information regarding your commercial payers. Click on a payer name below to display full billing and reimbursement information. (Updated January 9, 2021)

Products

Medicare and Medicare Advantage

Telemedicine Policy (Baseline)

CMS Telehealth Services Training

COVID-19 Telemedicine Policy

CMS Fact Sheet update 3/17

Coverage and Payment Related to COVID-19 Medicare

1135 Federal Waiver modifies guidelines for telemedicine coding, documentation and reimbursement

COVID-19 Resource Page

CMS Coronavirus Partner Virtual Toolkit

COVID-19 Coding Resources

CMS Fact Sheet update 3/17

Medicare Telemedicine Coding Documentation 

Traditional Telemedicine Codes (e.g., 99201-99205;99211-99215)

YES — Synchronous virtual care required per traditional CMS policy; temporary expansion to include urban as well as rural as of 3/17/20 (retro to 3/6/20); NOT allowing audio-only with traditional telemedicine CPTs. Bill with POS services WOULD have been rendered if not during PHE (i.e. POS 11).  SWHR Attestations can be performed with Traditional Telemedicine Codes.

Virtual Check-Ins (G2012/G2010)

YES per traditional CMS telemedicine policy

Telephonic (99441-99443)

YES, If patients or providers are having difficulty accessing the synchronous (audio and video) telecommunications, CMS has expanded the coverage of evaluation and management services (new or established patient) by telephone only. These visits cannot originate from a related E/M service or procedure within the previous seven days or lead to an E/M service or procedure within the next 24 hours or soonest available appointment​.

SWHR Attestations cannot be completed for telephone-only E/M services.

E-Visits (99421-99423, G2061-G2063)

YES per traditional CMS telemedicine policy

Exclusions based on Patient Coverage?

NO

Verifying Telemedicine Benefits (Real Time Eligibility (RTE), Payer Portals or Phone)

N/A — Included

Cost-Sharing

The Families First Coronavirus Response Act waives cost-sharing under Medicare Part B (coinsurance and deductible amounts) for Medicare patients for COVID-19 testing-related services.   COVID-19 testing-related services,  furnished between March 18, 2020 and the end of the Public Health Emergency (PHE); that result in an order for or administration of a COVID-19 test; are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test.  CS Modifier required.

Prior Auth Changes Regarding COVID-19

N/A

Referral Requirements

N/A

Timely Filing Extensions

N/A

Audit Changes

N/A

Products

Traditional Medicaid and Managed Medicaid

Telemedicine Policy (Baseline)

TMHP Telecommunication Guidelines

SHP Telehealth Guide

Molina Telemedicine/Telehealth Policy

COVID-19 Telemedicine Policy

COVID-19 Medical Audio Only

COVID-19 Behavioral Health Audio Only

COVID-19 Telemedicine Extension – Update Jan. 20, 2021 or if PHE extended Jan. 31, 2021

COVID-19 Resource Page

HHSC COVID-19 Provider Information

TMHP COVID-19 Resource Page

COVID-19 Coding Resources

COVID-19 Medical Audio Only

COVID-19 Behavioral Health Audio Only 

COVID-19 Vaccine

COVID-19 Vaccine Information

COVID-19 Vaccine Administration Procedure Codes 0001A and 0002A Are Now Benefits

Traditional Telemedicine Codes (e.g., 99201-99205;99211-99215)

YES — Synchronous virtual care required per traditional HHSC telemedicine policy (Medicaid); audio-only temporarily until January 20, 2021 or January 31, 2021 if PHE extended.

Virtual Check-Ins (G2012/G2010)

NO — HHSC/TMHP is allowing audio-only billed under standard E&M codes with Modifier 95 from March 20 until January 20, 2021 or January 31, 2021 if PHE extended.

Telephonic (99441-99443)

NO — HHSC/TMHP is allowing audio-only billed under standard E&M codes with Modifier 95 from March 20 until January 20, 2021 or January 31, 2021 if PHE extended.

E-Visits (99421-99423, G2061-G2063)

YES per traditional HHSC telemedicine policy (Medicaid)

Exclusions based on Patient Coverage?

NO

Verifying Telemedicine Benefits (Real Time Eligibility (RTE), Payer Portals or Phone)

N/A — Included

Cost-Sharing

N/A Medicaid Products; CHIP Waiver of CHIP Co-payments

To assist families in accessing care during the COVID-19 response, HHSC is waiving office visit co-payments for all CHIP members for services provided from March 13, 2020 until January 20, 2021 or January 31, 2021 if PHE extended.

Cost Share CHIP WaiverJanuary 20, 2021 or January 31, 2021 if PHE extended.

Prior Auth Changes Regarding COVID-19

COVID-19 Guidance for New and Initial Prior Authorizations –  January 20, 2021 or January 31, 2021 if PHE extended.

Referral Requirements

N/A

Timely Filing Extensions

N/A

Audit Changes

N/A

Products

Commercial (See Medicare and Medicare Advantage tab for Medicare Guidance)

Telemedicine Policy (Baseline)

Aetna Telemedicine Policy

COVID-19 Telemedicine Policy

Aetna COVID-19 Telemedicine Expansion 

Aetna’s liberalized coverage of Commercial telemedicine services, as described in its telemedicine policy, will continue until further notice.

COVID-19 Resource Page

Aetna Covid-19 Resource Page

COVID-19 Coding Resources

Aetna COVID-19 Billing & Coding FAQs

COVID-19 Vaccine

Aetna members in Commercial and Medicaid plans will not have to pay any out-of-pocket costs for a COVID-19 vaccine. For Medicare beneficiaries, CMS will cover the full cost of the vaccine, including those in a Medicare Advantage plan.

Aetna will cover any COVID-19 vaccine that has received FDA authorization, at no added cost to members.

CMS has provided additional guidance to plans, states and providers to ensure that the statutory requirements related to COVID-19 vaccination and coverage of administration costs are implemented as Congress intended. CMS issued the following payment allowances and related information for administering COVID-19 vaccines during the Public Health Emergency:

COVID-19 vaccine administration reimbursement rates:

  • 0001A – (Pfizer Admin): ADM SARSCOV2 30MCG/0.3ML 1ST – Rate: $16.94
  • 0002A – (Pfizer Admin): ADM SARSCOV2 30MCG/0.3ML 2ND – Rate: $28.39
  • 0011A – (Moderna Admin): ADM SARSCOV2 100MCG/0.5ML1ST – Rate: $16.94
  • 0012A – (Moderna Admin): ADM SARSCOV2 100MCG/0.5ML2ND – Rate: $28.39

Traditional Telemedicine Codes (e.g., 99201-99205;99211-99215)

YES Synchronous virtual care required if billing with E&M codes; Not allowing for Audio-only with traditional telemedicine CPTs see below Telephonic billing. Bill with POS 02 with the GT or 95 Modifier. Aetna had formerly approved the use of the POS where services would have been rendered if not during PHE (i.e., POS 11) but 4/17/20 Aetna announced they have update the Fee Schedules for POS 02 to pay same rate as face to face visit. Aetna will perform corrections if needed to claims billed with POS 11. For Medicare members, POS 02 or POS 11, or the POS equal to what it would have been had the service been furnished in-person, along with the 95 modifier indicating that the service rendered was actually performed via telehealth, may be utilized and will reimburse at the same rate.

Virtual Check-Ins (G2012/G2010)

YES — Please note, for telephone only codes (98966-98968, G2010, G2012) there are reimbursement rates in the fee schedule that are not the same as E&M office visits 99201-99215. Given those telephone only codes do not equate to an office visit, they will not result in an office visit reimbursement rate.

Telephonic (99441-99443)

YES — Telephone only services 99441-99443 are now set to equal 99212-99214 (e.g., 99441 is set to equate to 99212).

For Commercial plans, Aetna will continue to cover limited minor acute care evaluation and care management services, as well as some behavioral health services rendered via telephone, until further notice.

For providers with standard fee schedules, telephone-only services 99441 – 99443, when rendered between March 5, 2020 and September 30, 2020, were typically set to equal 99212 – 99214 (e.g. 99441 was set to equate to 99212). This rate change did not apply to all provider contracts (e.g. some non-standard reimbursement arrangements). After September 30, 2020, telephone-only services resumed to pre-March 5, 2020 rates.

E-Visits (99421-99423, G2061-G2063)

YES

Exclusions based on Patient Coverage?

YES — Commercial ASO Clients (Self Funded Employer Groups) may opt out of telemedicine or opt in to an exclusive vendor agreement. Recommended to verify benefits prior. THR and SWHR employers have confirmed will follow Telemedicine Policy for COVID-19. Allowing SWHR physicians to perform Telemedicine. Fully Insured Policies are required to by state statute to include telemedicine benefit. TDI is marked on ID Cards.

Verifying Telemedicine Benefits (Real Time Eligibility (RTE), Payer Portals or Phone)

Currently RTE nor Availity do not reflect if an ASO includes the Telemedicine benefit nor if there is an exclusive vendor. Please call to verify; Aetna is working on a potential solution.

Cost-Sharing

Aetna’s liberalized coverage of Commercial telemedicine services, as described in its telemedicine policy, will now extend through January 31, 2021.
  • Aetna extended all member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services through January 31, 2021 for their Commercial plans.  Aetna self-insured plan sponsors offer this waiver at their discretion.
  • Cost share waivers for any in-network covered medical or behavioral health services telemedicine visit for Aetna Student Health plans are extended until January 31, 2021.
  • Medicare Advantage will continue to waive cost shares for in-network primary care and specialist telehealth visits, including outpatient behavioral and mental health counseling services through January 31, 2021. Aetna Medicare Advantage members should continue to use telemedicine as their first line of defense for appropriate symptoms or conditions to limit potential exposure in physician offices. Cost sharing will be waived for all Teladoc® general medical care virtual visits. Cost sharing will also be waived for covered real-time virtual visits offered by in-network providers (live videoconferencing or telephone-only telemedicine services).
Aetna will waive member cost-sharing for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19. This policy applies to all Aetna-insured Commercial and Medicare Advantage plans and is effective immediately for any such admission through January 31, 2021. Self-insured plan sponsors offer this waiver at their discretion.

Prior Auth Changes Regarding COVID-19

COVID-19 Communications Update: Temporary Changes in Prior Authorization/Precertification for Skilled Nursing Facility(SNF) admissions

Prior authorization requests for commercial and Medicare Advantage members are being approved until the end of the plan year. Authorization may be extended beyond the plan year, for a period of six months, if continued eligibility can be confirmed.

Referral Requirements

​To address circumstances where PCP offices are closed due to COVID-19, Aetna has relaxed the PCP rule so no referral is necessary for Medicare Advantage plans. Aetna has not changed its PCP referral requirements for commercial plans.

Timely Filing Extensions

N/A

Accelerated Payments

N/A

Audit Changes

N/A

Products

Commercial (See Medicare and Medicare Advantage tab for Medicare Guidance)

Telemedicine Policy (Baseline)

BCBS Telemedicine and Telehealth Services prior to COVID
BCBSTX Telehealth 2021
NEW Telemedicine Policy Effective 1/1/21 – 2/11/21
NEW Telemedicine Policy Effective 2/12/21

COVID-19 Telemedicine Policy

BCBSTX COVID-19 Telemedicine and Telehealth Coverage Expansion COVID-19  – Ended December 31, 2021

Blue Cross and Blue Shield of Texas (BCBSTX) expanded our telemedicine/telehealth program in response to the COVID-19 crisis to provide greater access to medical and behavioral health services for our members. Our state-regulated fully insured HMO, PPO and our Medicare members have access through December 31, 2020.

BCBSTX Telehealth 2021
NEW Telemedicine Policy Effective 1/1/21 – 2/11/21
NEW Telemedicine Policy Effective 2/12/21

In response to the COVID-19 pandemic, Blue Cross and Blue Shield of Texas (BCBSTX) expanded access to telehealth services to give BCBSTX members greater access to care. The experience confirmed the importance of telehealth in health care delivery. Members can access their medically necessary, covered benefits through providers who deliver services through telehealth. Many of our members also have access to various telehealth vendors, such as MDLIVE.

For state-regulated fully insured members, providers are not required to use a vendor for telehealth services. For self-funded members, providers may be required to use specific vendors as outlined in the member’s benefit plan.  Recommend verification.

Telemedicine and Telehealth

Coverage – Providers can use telehealth for members with the following types of benefit plans. Care must be consistent with the terms of the member’s benefit plan.

  • State-regulated fully insured HMO and PPO plans
  • Blue Cross Medicare Advantage (excluding Part D) and Medicare Supplement (see Medicare info below)
  • Self-funded employer group plans

Commercial Members – As of January 1, 2021, for BCBSTX state regulated fully insured HMO and PPO members and BCBSTX self-funded employer group members, BCBSTX will cover telehealth codes consistent with the permanent code lists from:

By permanent, BCBSTX means those codes that are not temporarily available for the duration of the public health emergency (PHE) or the year of the PHE.

CMS and AMA periodically update their lists. BCBSTX will follow their updates.

BCBSTX will not cover the following codes:

  • Codes that are not on the telemedicine code list provided by CMS or the AMA
  • CMS codes that are temporary for the PHE
  • CMS Codes that are active for the year of the PHE only
  • AMA codes listed as Private Payer

Medicare Members – CMS identifies covered services for Medicare members. This means we will cover all the CMS telemedicine codes, including those available only during the PHE for Medicare Advantage and Medicare Supplement members.

COVID-19 Resource Page

BCBSTX COVID-19 Preparedness
BCBSTX COVID-19 Related News
BCBSTX COVID-19 Medicare FAQs
BCBSTX Telehealth 2021

COVID-19 Coding Resources

BCBSTX Telehealth 2021
NEW Telemedicine Policy Effective 1/1/21 – 2/11/21

NEW Telemedicine Policy Effective 2/12/21

COVID-19 Vaccines

COVID-19 Vaccines and Coverage

Fully insured:

  • Vaccine and administration covered as a preventive service with no cost-share to members at in-network providers
  • Vaccine and administration covered with no cost-share to members if delivered at out-of-network providers through the end of the public health emergency

Self-funded employer groups:

  • Non-grandfathered self-funded employer groups – vaccine and administration covered as a preventive service with no cost-share to members at in-network providers
  • Vaccine and administration covered at no cost-share to members at out-of-network providers through the end of the public health emergency
  • Self-funded employer groups that don’t cover preventive vaccines through their pharmacy benefit must cover the vaccine through their medical benefit
  • Grandfathered plans are not required to cover preventive services, including the COVID-19 vaccine

Medicare Advantage and Medicare Supplement:

  • For 2020 and 2021, Medicare payment for the COVID-19 vaccine and its administration will be through the original fee-for-service Medicare program.
  • Submit claims for administering the COVID-19 vaccine to the CMS Medicare Administrative Contractor (MAC) using product-specific codes for each vaccine approved.
  • Members will have no cost-sharing on vaccines through December 31, 2021.

Coding claims: CMS and the American Medical Association (AMA) have identified the codes to use in submitting claims. For more information, see CMS’ guidance.

Code Use Description
91300 Vaccine Pfizer-Biontech Covid-19 Vaccine SARSCOV2 VAC 30MCG/0.3ML IM
0001A Admin Pfizer-Biontech Covid-19 Vaccine Administration – First Dose ADM SARSCOV2 30MCG/0.3ML 1ST
0002A Admin Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose ADM SARSCOV2 30MCG/0.3ML 2nd
91301 Vaccine Moderna Covid-19 Vaccine SARSCOV2 100MCG/0.5ML IM
0011A Admin Moderna Covid-19 Vaccine Administration – First Dose ADM SARSCOV2 100MCG/0.5ML1st
0012A Admin Moderna Covid-19 Vaccine Administration – Second Dose ADM SARSCOV2 100MCG/0.5ML2nd

Reimbursement:

  • In-network providers will be reimbursed for the administration fee based on contracted rates.
  • Out-of-network providers will be reimbursed based on established OON reimbursement policy that follows Medicare rates.

Balance billing: Providers are prohibited from billing patients for the vaccine or its administration, including balance billing, if the provider received the vaccine at no cost from the government.

Traditional Telemedicine Codes (e.g., 99201-99205; 99211-99215)

  • For more information refer to the Telemedicine and Telehealth section above.
  • The provider submitting the claim is responsible for accurately coding the service performed. Submit claims for medically necessary services delivered via telehealth with the appropriate modifiers (95, GT, GQ, G0) and Place of Service (POS) 02.Acceptable modifiers:
    95 – synchronous telemedicine (two-way live audio visual)
    GT – interactive audio and video telecommunications
    GQ – asynchronous
    G0 – telehealth services for diagnosis, evaluation or treatment of symptoms of an acute stroke; G0 must be billed with one of the approved telemedicine modifier (GT, GQ or 95).

    Note: If a claim is submitted using a telehealth code, no modifiers are necessary. Only codes that are not traditional telehealth codes require a modifier.

    • Currently, covered telehealth claims for eligible members for in-network medically necessary health care services will be reimbursed at the same rate as in-person office visits for the same service. We will continue to evaluate reimbursement. Submit claims with appropriate codes and modifiers. For claims using a specific telehealth code, the applicable telehealth reimbursement will apply.

Virtual Check-Ins (G2012/G2010)

No

Telephonic (99441-99443)

  • For more information refer to the Telemedicine and Telehealth section above.
  • Medicare Members only see below
    • Available telehealth visits with BCBSTX providers include:
      • 2-way, live interactive telephone communication (audio only) and digital video consultations
      • Asynchronous telecommunication via image and video not provided in real-time (a service is recorded as video or captured as an image; the provider evaluates it later)
      • Other methods allowed by state and federal laws, which can allow members to connect with physicians while reducing the risk of exposure to contagious viruses or further illness

      Delivery methods for Medicare members

      • Providers should use an interactive audio and video telecommunications system that permits real-time interactive communication to conduct telehealth services. CMS permits audio only in limited circumstances. See the CMS website for designated audio-only codes.

      Providers can find the latest guidance on acceptable Health Insurance Portability and Accountability Act (HIPAA) compliant remote technologies issued by the U.S. Department of Health and Human Services’ Office for Civil Rights in Action.

E-Visits (99421-99423, G2061-G2063)

  • For more information refer to the Telemedicine and Telehealth section above.

Exclusions based on Patient Coverage?

YES — Commercial ASO Clients (Self-Funded Employer Groups) may opt out of telemedicine or opt in to an exclusive vendor agreement. Recommended to verify benefits prior. NOTE: UT Select/Connect have confirmed will follow Telemedicine Policy for COVID-19. Allowing SWHR physicians to perform Telemedicine. Fully Insured Policies are required to by state statute to include telemedicine benefit. TDI is marked on ID Cards.

For state-regulated fully insured members, providers are not required to use a vendor for telehealth services. For self-funded members, providers may be required to use specific vendors as outlined in the member’s benefit plan.  Recommended to verify

Verifying Telemedicine Benefits (Real Time Eligibility (RTE), Payer Portals or Phone)

See tip sheet (PDF) on how to verify if a Self-Funded plan offers the Telemedicine Benefit. Exclusive Telemedicine Vendor may still restrict reimbursement at this time it is recommended to call and verify.

BCBSTX self-funded employer group customers make decisions for their employee benefit plans. Check eligibility and benefits for any variations in member benefit plans.  For state-regulated fully insured members, providers are not required to use a vendor for telehealth services. For self-funded members, providers may be required to use specific vendors as outlined in the member’s benefit plan.

BCBSTX recommends the following:

  • Consider telehealth a mode of care delivery to be used when it can reasonably provide equivalent outcomes as face-to-face visits.
  • Choose telehealth when it enhances the continuity of care and care integration if you have an established patient-provider relationship with members.
  • Integrate telehealth records into electronic medical record systems to enhance continuity of care, maintain robust clinical documentation and improve patient outcomes.

Cost-Sharing

As of January 1, 2021, copays, deductibles and coinsurance apply to telehealth visits for most members. The cost share varies according to the member’s benefit plans. Check eligibility and benefits for each member for details.

Our self-funded employer group customers make decisions for their employee benefit plans and may choose to waive telemedicine cost share. Check eligibility and benefits for any variations in member benefit plans.

For the duration of the PHE, BCBSTX is waiving cost share for our Medicare Advantage members. This means these members will not owe any copays, deductibles or coinsurance for telehealth visits. The cost share waiver does not apply to Medicare Supplement members.

Prior Auth Changes Regarding COVID-19

Some telehealth care will require referrals and prior authorizations in accordance with the member’s benefit plan. Check eligibility and benefits for each member for details.

Referral Requirements

Some telehealth care will require referrals and prior authorizations in accordance with the member’s benefit plan. Check eligibility and benefits for each member for details.

Timely Filing Extensions

N/A

Audit Changes

N/A

Products

Commercial Only

Telemedicine Policy (Baseline)

*Traditional Telemedicine Policy — Prior Exclusive to e.g., MDLive/WellMD; NOTE: Cigna expanded temporarily due to COVID-19

October 16, 2020, Cigna announced a permanent Virtual Care Reimbursement Policy for commercial medical services effective January 1, 2021.

Beginning January 1, 2021, Cigna will implement a new Virtual Care Reimbursement Policy to ensure continued reimbursement of virtual care services at face-to-face rates.

COVID-19 Telemedicine Policy

Cigna COVID-19 Interim Billing Guidelines  – Ends December 31, 2020

Beginning January 1, 2021, Cigna will implement a new Virtual Care Reimbursement Policy to ensure continued reimbursement of virtual care services at face-to-face rates.

COVID-19 Resource Page

Cigna COVID-19 Resource Page

Cigna COVID-19 Interim Billing Guidelines – Ends December 31, 2020

Beginning January 1, 2021, Cigna will implement a new Virtual Care Reimbursement Policy to ensure continued reimbursement of virtual care services at face-to-face rates.

COVID-19 Coding Resources

Cigna COVID-19 Interim Billing Guidelines – Ends December 31, 2020

Beginning January 1, 2021, Cigna will implement a new Virtual Care Reimbursement Policy to ensure continued reimbursement of virtual care services at face-to-face rates.

COVID-19 Vaccine

Effective 8-1-20, Antibody testing will only be covered for ages 21 and younger.

Coding: Cigna covers the administration of the COVID-19 vaccine with no customer cost-share (i.e., no deductible or co-pay) when delivered by any provider or pharmacy.

After the EUA or licensure of each COVID-19 vaccine product by the FDA, CMS will identify the specific vaccine code(s) along with the specific administration code(s) for each vaccine. For the COVID-19 vaccines that are available as of December 2020, Cigna will reimburse the administration of the vaccine at the established national CMS rates, as follows:

Code Descriptor Vaccine name and dose Reimbursement Effective date
0001A ADM SARSCOV2

30MCG/0.3ML 1ST

Pfizer-BioNTech COVID-19 Vaccine Administration – First Dose $16.94 December 11, 2020
0002A ADM SARSCOV2

30MCG/0.3ML 2ND

Pfizer-BioNTech COVID-19 Vaccine Administration – Second Dose $28.39
0011A ADM SARSCOV2

100MCG/0.5ML 1ST

Moderna COVID-19 Vaccine Administration – First Dose $16.94 December 18, 2020
0012A ADM SARSCOV2

100MCG/0.5ML 2ND

Moderna COVID-19 Vaccine Administration – Second Dose $28.39

Additional FDA EUA approved vaccines will be covered consistent with this guidance.

For additional information about our coverage of the COVID-19 vaccine, please review our COVID-19 Vaccine coverage policy.

CS Modifier – No additional modifiers are necessary. Billing the appropriate administration code will ensure that cost-share is waived.

Cost of Vaccine – The government is providing the initial vaccine doses free of charge to health care providers, Cigna will not reimburse providers for the cost of the vaccine itself. Providers can, however, bill the vaccine code (e.g., 91300 for the Pfizer vaccine and 91301 for the Moderna vaccine) with a nominal charge (e.g., $.01), but it is not required to be billed in order to receive reimbursement for the administration of the vaccine.

Billing Patients – Providers that receive the COVID-19 vaccine free of charge from the federal government are prohibited from seeking reimbursement from consumers for vaccine administration costs – whether as cost sharing or balance billing. Providers that administer vaccinations to patients without health insurance or whose insurance does not provide coverage of vaccination administration fees, may be able to file a claim with the provider relief fund, but may not charge patients directly for any vaccine administration costs.

Cigna Medicare Advantage Coverage – Providers should bill Cigna for the administration of the vaccine for patients with a commercial Cigna-administered benefit plan, while providers should bill Original Medicare for all patients enrolled in Medicare Advantage.  For additional information about Cigna Medicare COVID-19 guidance, including vaccine reimbursement, please review the Cigna Medicare website.

Traditional Telemedicine Codes (e.g., 99201-99205; 99211-99215)

YES – Synchronous and Audio-only temporarily – until December 31, 2020. Bill with POS services WOULD have been rendered if not during PHE (i.e., POS 11).

Virtual and eConsults visits policy, as is of July 17, 2020, has been extended out to December 31, 2020.

In an effort to make it as easy as possible for Cigna customers to access timely and safe care, while ensuring that providers can continue to deliver necessary services in safe settings, Cigna will allow providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19, through December 31, 2020.

Beginning January 1, 2021, Cigna will implement a new Virtual Care Reimbursement Policy to ensure continued reimbursement of virtual care services at face-to-face rates.

Virtual Check-Ins (G2012/G2010)

YES —

  • Must be performed by a licensed provider
  • Cost-share will be waived until October 31, 2020
  • Coverage applies until December 31, 2020

Beginning January 1, 2021, Cigna will implement a new Virtual Care Reimbursement Policy to ensure continued reimbursement of virtual care services at face-to-face rates.

Telephonic (99441-99443)

NO – see “Traditional Telemedicine Codes” section

E-Visits (99421-99423, G2061-G2063)

NO

Exclusions based on Patient Coverage?

Beginning January 1, 2021, Cigna will implement a new Virtual Care Reimbursement Policy to ensure continued reimbursement of virtual care services at face-to-face rates.

Verifying Telemedicine Benefits (Real Time Eligibility (RTE), Payer Portals or Phone)

Since Cigna normally has exclusive vendors perform all Telemedicine services. Cigna does not list any benefit information on RTE or Payer Portals. It is recommended to call the Cigna C/S to verify.

Cost-Sharing

COVID-19 Related services – The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place until January 21, 2021 and COVID-19 related treatment is in place until February 15, 2021.

  • Suspected/Likely COVID-19 exposure – Cost-share will be waived only for COVID-19 related services when providers bill the appropriate ICD10 code and modifier CS (Modifier CR or condition code DR can also be billed instead of CS)
  • Confirmed COVID-19 case – Cost-share will be waived only when providers bill the appropriate ICD10 code (U07.1).  Note that billing B97.29 will no longer waive cost-share. Effective August 1, 2020, U07.1 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnoses

Non COVID-19 Related

  • Virtual Screening telephone consults (G2012) – Cost-share will be waived for all services (including non COVID-19 related services) until October 31, 2020
  • Non COVID-19 virtual visit (i.e. telehealth) – Standard cost-share will apply
  • In-office visit not related to COVID-19 Standard cost-share will apply
  • Cigna Medicare Advantage is waiving cost-share for certain non-COVID-19 related office visits through December 31, 2020.

Prior Authorization Changes Regarding COVID-19

Cigna continues to require prior authorization reviews for routine advanced imaging. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. Approximately 98% of reviews are completed within two business days of submission. Cigna continues to monitor the COVID-19 outbreak and will change requirements as appropriate. Please note that Cigna has temporarily increased the precertification approval window for all elective inpatient and outpatient services – including advanced imaging – from three months to six months for dates of authorization beginning March 25, 2020 through March 31, 2021.

In order to help facilitate freeing up bed space for COVID-19 patients, and for the expressed purpose of freeing up bed space for COVID-19 acute inpatient admissions, Cigna will allow direct emergent or urgent transfers from an acute inpatient facility to a second acute inpatient facility, skilled nursing facility (SNF), acute rehabilitation facility (AR), or long-term acute care hospital (LTACH) without prior authorization until March 31, 2021 for both commercial and Medicare businesses.

  • The second acute inpatient facility, SNF, AR, or LTACH facility is responsible for notifying Cigna of admissions the next business day.
  • Coverage reviews for appropriate levels of care and medical necessity still apply to SNF, AR, and LTACH admissions.
  • Concurrent review will start the next business day with no retrospective denials.
  • Per usual policy, Cigna does not require three days of inpatient care prior to transfer to an SNF.

Please note that routine and non-emergent transfers to SNF, AR, and LTACH continue to require precertification, and if a hospital is not at capacity and requiring the need to free up bed space for COVID-19, all of these transfers still require precertification.

Referral Requirements

N/A

Timely Filing Extensions

Cigna will make every effort to accommodate facilities and provider groups who are adversely affected by COVID-19, as appropriate. For all claims and appeals with timely filing periods that expired on or after March 1, 2020, timely filing periods will be extended until March 1, 2021 when determining certain established plan-related periods and dates. At that time, those claims and appeals will be accepted and processed if submitted within the number of days that remained under the timely filing period as of March 1, 2020.

Accelerated Payments

N/A

Audit Changes

Cigna will also closely monitor and audit claims for inappropriate services that should not be performed virtually (including but not limited to: acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, and EEG or EKG testing).

Products

Commercial (See Medicare and Medicare Advantage for Medicare Guidance)

Telemedicine Policy (Baseline)

Telehealth Commercial – Updated: January 1, 2021

COVID-19 Telemedicine Policy

Temporary Covid-19 Telemedicine Policy (all LOBs)
UHC Summary of COVID-19 Dates by Program Grid – Updated: January 11, 2021

Medicare Advantage –
  • COVID-19 related services – UnitedHealthcare will extend the expansion of telehealth access for in- and out-of-network providers through the national public health emergency period, currently scheduled to end April 20, 2021, UnitedHealthcare will cover all in-network and out-of-network telehealth services as outlined in the current CMS guidelines.
  • Non-COVID-19 related services – UnitedHealthcare will extend the expansion of telehealth access for in- and out-of-network providers through the national public health emergency period, currently scheduled to end April 20, 2021, UnitedHealthcare will cover all in-network and out-of-network telehealth services as outlined in the current CMS guidelines.
  • (See the Medicare Advantage section on UHCprovider.com/covid19 > Telehealth)
Commercial –
  • COVID-19 related services – From January 1, 2021 and beyond, UnitedHealthcare will reimburse in-network telehealth services as outlined in current CMS guidelines and additional codes as outlined in our UHC telehealth reimbursement policy.
  • Non-COVID-19 related services – For in-network providers, UnitedHealthcare will extend the expansion of telehealth access through December 31, 2020. From January 1, 2021, UnitedHealthcare will cover in-network telehealth services in accordance with the member’s benefit plan and UHC telehealth reimbursement policy. During the national public health emergency period, currently scheduled to end April 20, 2021, additional CMS codes may apply
  • (See the Individual and Fully Insured Group Market Health Plan section on UHCprovider.com/covid19 > Telehealth)
  • The temporary policy changes apply to members whose benefit plans cover telehealth services and allow those patients to connect with their doctor through live, interactive audio-video or audio-only visits.
  • Self-Insured – Implementation of these temporary changes for self-funded customers may vary. Depending on a member’s health plan, providers may need to adjust their administrative processes and systems when collecting member cost share (copays, coinsurance and deductibles). To determine if a member has a self-funded plan, please call UnitedHealthcare Provider Services at 877-842-3210.

COVID-19 Resource Page

UHC COVID-19 Resource Library

COVID-19 Coding Resources

UHC COVID-19 new ICD-10/CPT changes
UHC COVID-19 Informational Videos
UHC COVID-19 Testing and Testing-Related Services Billing Guide – Updated: January 11, 2021
UHC COVID-19 Telehealth Coding Guidance – Updated: December 21, 2020

COVID-19 Vaccine

Claim Payments: UnitedHealthcare will begin paying COVID-19 vaccine administration claims once CMS rates are published.

Cost of Vaccine: The COVID-19 vaccine serum will initially be paid by the U.S. government.

Patient Cost Share: Eligible members receiving the vaccine will not have any out-of-pocket costs (copayment, coinsurance or deductible), whether for the vaccine or the vaccine administration when the U.S. government provides the vaccine. Health care professionals should not bill members for these claims.  For Individual and Group Market* health plans, UnitedHealthcare and self-funded customers will be required to cover the administration of COVID-19 vaccines with no cost share (copayment, coinsurance or deductible) for in- and out-of-network providers, during the national public health emergency period. Administration fees for in-network providers will be based on contracted rates. Administration fees for out-of-network providers will be based on CMS published rates.

Coding: UnitedHealthcare aligns with America Medical Association (AMA) CPT® coding for medical claims. Health care professionals should use published AMA CPT codes when submitting COVID-19 vaccine administration claims to UnitedHealthcare under the member’s medical benefit. Currently Approved AMA CPT Codes

Additional codes will be added as they become available.  Codes will be added to all applicable provider fee schedules as part of the standard quarterly code update and any negotiated discounts and premiums will apply to these codes. Codes will be added using the CMS published effective date for the codes and payment allowance as the primary fees source.

Modifiers: Modifiers are not required when submitting COVID-19 vaccine administration claims through the member’s medical benefit.

Traditional Telemedicine Codes (e.g., 99201-99205; 99211-99215)

YES Synchronous virtual care required per traditional telemedicine policy. Bill with POS services WOULD have been rendered if not during PHE (i.e., POS 11); See UHC billing guide 

UHC COVID-19 Testing and Testing-Related Services Billing Guide – Updated: January 11, 2021
UHC COVID-19 Telehealth Coding Guidance – Updated: December 21, 2020
Telehealth Commercial– Updated: December 21, 2020

Virtual Check-Ins (G2012/G2010)

YES

Medicare Advantage – Covered

Commercial

  • COVID-19 related services For new patients, UnitedHealthcare will extend the expansion of telehealth access for in-network providers for COVID-19 testing and treatment through April 21, 2021. From January 1, 2021 and beyond, UnitedHealthcare will cover all in-network telehealth services as outlined in current CMS guidelines and additional codes as outlined in our telehealth reimbursement policy.
  • Non-COVID-19 related services For new patients, UnitedHealthcare will extend the expansion of telehealth access for in-network providers through April 21, 2021.

Telephonic (99441-99443)

YES — See UHC billing guide 

E-Visits (99421-99423, G2061-G2063)

YES

Medicare Advantage – Covered

Commercial E-visits will be covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy.

Additional Details

UnitedHealthcare will reimburse providers when members communicate with their doctors using online patient portals, using CPT® codes 99421-99423 and HCPCS codes G2061- G2063. For these e-visits, the member must generate the initial inquiry, and communications can occur over a seven-day period.

UHC COVID-19 Testing and Testing-Related Services Billing Guide – Updated: January 11, 2021
UHC COVID-19 Telehealth Coding Guidance – Updated: December 21, 2020
Telehealth Commercial– Updated: December 21, 2020

Exclusions based on Patient Coverage?

YES — Commercial ASO Clients (Employer Groups) may opt out of telemedicine. During COVID-19 UHC has stated they will allow in- or out-of-network providers see their patients and not require to use exclusive Telemedicine vendors. Note: ASOs may not have the telemedicine benefit if not included reimbursement would be impacted. Fully Insured Policies are required to by state statute to include telemedicine benefit. TDI is marked on ID Cards.

Verifying Telemedicine Benefits (Real Time Eligibility (RTE), Payer Portals or Phone)

See tip sheet (PDF) on how to view if a plan is Self-Funded and if the plan offers the Telemedicine Benefit.

Cost-Sharing

UHC Summary of COVID-19 Dates by Program Grid – Updated: January 11, 2021

Medicare Advantage –
  • COVID-19 related services –
    • COVID-19 Testing – UnitedHealthcare will extend the expansion of telehealth access for in- and out-of-network providers through the national public health emergency period, currently scheduled to end April 20, 2021.
    • COVID-19 Treatment – From February 4, 2020 through January 31, 2021, UHC is waiving cost sharing for in-network and out-of-network telehealth treatment visits.
  • Non-COVID-19 related UnitedHealthcare will extend the cost share waiver for telehealth services for in- and out of-network primary care providers through December 31, 2020.  As of October 1, 2020, cost sharing for non-primary care telehealth services will be adjudicated in accordance with the member’s benefit plan. In 2021, cost sharing for telehealth services will be determined according to the member’s benefit plan.  Most of our Medicare Advantage plans have $0 copayments for covered telehealth services in 2021.
Commercial –
  • COVID-19 Testing – UnitedHealthcare will extend the expansion of telehealth access for in- and out-of-network providers through the national public health emergency period, currently scheduled to end April 20, 2021.
  • COVID-19 Treatment – From February 4, 2020 through December 31st, 2020, UHC is waiving cost sharing for in-network telehealth treatment visits.  Effective January 1, 2021, most benefit plans include telehealth visits with in-network providers. Members will be responsible for any copay, coinsurance or deductible according to their benefit plan. Here is a link to the updated reimbursement policy effective January 1, 2021.
  • Non-COVID-19 – For in-network providers, UnitedHealthcare extended the cost share waiver for telehealth services through September 30, 2020. For out-of-network providers, the cost share waiver for telehealth services does not apply. As of October 1, 2020, benefits will be adjudicated in accordance with the member’s benefit plan.

Prior Auth Changes Regarding COVID-19

To streamline operations for providers, UHC is extending prior authorization timeframes for open and approved authorizations and we’re suspending prior authorization requirements for many services. Review each of the sections below for effective dates and specific details. Please check back often for the latest information.

Prior Authorization Updates

  • In-Network Hospital and SNF Prior Authorization Suspensions in Effect December 18, 2020 – January 31, 2021
  • Genetic and Molecular CPT Code/Prior Authorization Update Beginning October 1, 2020
  • Extensions of Existing Prior Authorizations
  • Diagnostic Radiology for COVID-19
  • Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
  • Infertility Treatments and Embryo Cryopreservation – Update on Guidance and Coverage
  • Post-Acute Care Admissions
  • Site of Service Reviews
  • Transfers to a New Provider

Referral Requirements

  • Medicare Advantage: As a result of the emergency order, beginning March 1, 2020: UHC is not enforcing referral requirements for Medicare Advantage plans during the national public health emergency period. For dates of service through April 20, 2021, referrals do not need to be entered into Link for plans that otherwise require that process.
  • Individual and Group Market Health Plans: Consistent with existing policy, members do not need a referral for emergency care. All other standard referral requirements continue to apply. If a patient is unable to contact their primary care provider (PCP), they can contact Member Services for assistance with a referral. The number for Member Services can be found on their health plan ID card.  Referrals are not required for primary care visits for any of our plans. However, some plans may have referral requirements for specialists that were in place before the national public health emergency period. You can use UHC referral link tool to submit and check member referrals for all benefit plans.

Timely Filing Extensions

Medicare Advantage –

Claims with a 2020 service date submitted on or after January 1, 2020, through June 30, 2020, will not be denied for failure to meet timely filing deadlines. As of July 1, 2020, UnitedHealthcare is following standard timely filing requirements.

Additional Details

  • If the Centers for Medicare & Medicaid Services (CMS) issues further guidance on timely filing, UnitedHealthcare will adhere to that guidance.
  • UHC standard timely filing requirements apply to claims that exceeded requirements prior to the national emergency period.**

Commercial –

UnitedHealthcare is following the IRS/DOL regulation related to the national emergency declared by the President. This regulation pauses the timely filing requirements time clock for claims that would have exceeded the filing limitation during the national emergency period that began on March 1, 2020.
Additional Details
  • Timely filing requirements have been extended an additional 60 days following the last day of the national emergency period.** This regulatory guidance has been issued by the IRS and the U.S. Department of Labor (Employee Benefits Security Administration).
  • UHC standard timely filing requirements apply to claims that exceeded requirements prior to the national emergency period.**

Accelerated Payments

For claims submitted on or after April 7, providers may receive payment anywhere from a few days to two weeks earlier than usual. Other financial support currently includes the provision for up to $125 million in small business loans to clinical operators with whom OptumHealth is partnered.

Audit Changes

N/A

Products

Commercial (See the Medicare and Medicare Advantage tab for Medicare Guidance)

Telemedicine Policy (Baseline)

Humana Telehealth Services Policy

Humana Telehealth and Other Virtual Services – Updated: January 8, 2021

COVID-19 Telemedicine Policy

Telemedicine Expansion
Humana COVID-19 FAQ (updated June 17, 2020)
Humana COVID-19 Testing FAQs (updated October 16, 2020)
Humana Telehealth FAQs
Humana Telehealth and Other Virtual Services – Updated: January 8, 2021
Humana Telehealth Reference Guide
Humana 2021 Plan Changes FAQ – Updated: December 31, 2020

Temporary expansion of telehealth service scope and reimbursement rules: To ease systemic burdens arising from COVID-19 and support shelter-in-place orders, Humana is encouraging the use of telehealth services to care for its members. Humana will temporarily reimburse for telehealth visits at the same rate as in-office visits. In order to qualify for reimbursement, telehealth visits must meet medical necessity criteria, as well as all applicable coverage guidelines. Humana understands that not all telehealth visits will involve the use of both video and audio interactions. For providers or members who don’t have access to secure video systems, we will temporarily accept telephone (audio-only) visits. These visits can be submitted and reimbursed as telehealth visits. Please follow CMS or state-specific guidelines and bill as you would a standard telehealth visit.

COVID-19 Resource Page

Humana COVID-19 Resource Page

COVID-19 Coding Resources

Humana Diagnosis Code Guide

COVID-19 Vaccine

Vaccine FAQs

Traditional Telemedicine Codes (e.g., 99201-99205; 99211-99215)

YES Synchronous virtual care required per traditional telemedicine policy, Bill with POS services WOULD have been rendered if not during PHE (i.e., POS 11); Audio-only temporarily (TBD)

Humana is reimbursing an office visit furnished via telehealth by an in-network practitioner at the same rate as an in-person office visit. To enable such claims processing, Humana strongly recommends that a provider submit a charge for a telehealth service with the place of service (POS) code that would have been reported had the service been furnished in person and to append modifier 95 to identify that the service was furnished via telehealth.

Virtual Check-Ins (G2012/G2010)

YES

Telephonic (99441-99443)

YES

E-Visits (99421-99423, G2061-G2063)

Excluded from traditional telemedicine policy; Humana has not notified SWHR of E-Visits being included. Only blanket statement of please follow CMS or state-specific guidelines. Handle with care.

Exclusions based on Patient Coverage?

YES – Commercial ASO Clients (Employer Groups) may opt out of telemedicine or opt into an exclusive vendor agreement. Recommended to verify benefits prior. Fully Insured Policies are required to by state statute to include telemedicine benefit. TDI is marked on ID Cards.

Verifying Telemedicine Benefits (Real Time Eligibility (RTE), Payer Portals or Phone)

See tip sheet (PDF) on how to verify if a Self-Funded plan offers the Telemedicine Benefit.

Cost-Sharing

For the 2021 plan year, Humana will cover out-of-pocket costs for COVID-19 treatment for Humana Medicare Advantage members. Eligible members will have no copays, deductibles or coinsurance out-of-pocket costs for covered services for treatment of confirmed cases of COVID-19, regardless of where the treatment takes place. This could include telehealth, primary care physician visits, specialty physician visits, facility visits, labs, home-health, and ambulance services. Members are encouraged to check their plan documents for details about their 2021 coverage.

Effective January 1, 2021, employer group members’ standard benefits and cost-sharing will apply for COVID-19 treatment.

Note: This does not apply to Part D-only plan members. Part D-only plan members continue to be eligible for prescription benefits.

CS Modifier: Humana is waiving the office visit cost-sharing, and it’s not necessary to bill the office visit and the testing on the same claim. However, to ensure that the cost-sharing is waived, a claim for an office visit related to COVID-19 testing should include Modifier CS and the appropriate ICD-10-CM diagnosis code(s) indicating that the service was related to COVID-19 testing. The cost-sharing waiver also includes follow-up visits via telehealth and other virtual methods. Include Modifier CS if office visit related to COVID-19 testing with the appropriate ICD-10-CM diagnosis code(s).

Prior Authorization Changes Regarding COVID-19

As of January 6, 2021 – Humana SNF Authorization Changes

In response, Humana is suspending authorization requirements for skilled nursing facilities (SNFs) for Medicare Advantage and commercial members in the entire state of Texas through January 31, 2021.

NaviHealth will continue to work with SNF facility-based teams on concurrent review for length of stay and appropriate level of care, including discharge planning. Please provide notification of admission within 24 hours to allow us to track our members’ progress and provide assistance with discharge planning. You will receive an approval when you submit the notification. This suspension applies to participating/in-network providers only.

Important details:

  • Authorization suspension, as outlined herein, will continue through January 31, 2021.
  • This suspension applies to participating/in-network providers only.
  • Please provide notification of admission within 24 hours to allow us to track our members’ progress. You will receive an approval when you submit the notification.
  • No other services requiring prior authorization are included in this suspension.

Referral Requirements

Humana is expanding this suspension to include suspending nearly all pre-authorization requirements for participating/in-network providers. This applies to inpatient (acute and post-acute), outpatient, and all referrals for Humana’s individual and Group Medicare Advantage, Commercial Group, and Medicaid plans.

Timely Filing Extensions

N/A

Accelerated Payments

Humana does not have any accelerated payment program. Humana however did release delays in payment processing

  • Processing telehealth claims: Humana enacted a new telehealth policy on March 6. To ensure we process telehealth claims accurately and avoid additional receivables posting and rework for providers, Humana began pending telehealth claims beginning in mid-March. Humana began to process telehealth claims again the week of April 20, with a priority on processing previously pended claims first. Humana expects to have all pended claims processed and to begin normal processing of telehealth claims the week of April 27.

Audit Changes

Effective April 1, Humana will suspend all medical records requests for pre-and post-paid claim review processes for individual and Group Medicare Advantage, Commercial Group, and Medicaid. This suspension applies to all professional and facility claims from in-network and out-of-network providers. Humana will release any claims currently under medical record review as of April 1 and issue payment to providers. Although medical record claim reviews are suspended, we may request medical records retrospectively once the suspension is lifted.