Tuesday, May 26, 2020, 12:06 pm EST:
Below is an updated cheat sheet about how several of the major payers are handling Telemedicine. If you have printed a copy of the previous version(s) please replace it with this one. Changes are in bold.
A few patterns that are showing up:
- Following Medicare’s lead, more insurance companies are making phone only visits available and better paying. Now Cigna, Humana and UHC will allow you to bill your normal office visit codes for phone only visits. The other payers have added in the 99441-99443 codes, however they have not increased the fees on those codes as Medicare has. We are charging the higher rates on those codes for all payers, so if those policies change we will already be prepared.
- Most telehealth policies were initially scheduled to be short term; we are starting to see those dates get pushed out, however we are also starting to see them put end dates on the cost share waivers.
- We’re seeing more alignment in the POS and modifier requirements. While Aetna and BCBS have more liberal telehealth policies under normal circumstances and can therefore handle the telehealth POS of 02, all the rest have settled on the normal face to face POS (typically 11). They have also all settled on modifier 95, with the notable exception of Medicaid which is still requiring GT.
| Insurance | Video Visit | Telephone Visit | Annual Wellness Visit | Timeframe allowed | Cost Share | Other |
| Aetna | 99201-99215 with POS 02 and modifier 95 | 99441-99443 or G2012 with POS 02 through Aug 4. There is not a fee increase on these codes | G0438 -G0439 with 02 and 95 | Aetna covers video visits normally | Waived through 6/4 | |
| BCBS FL
|
99201-99215 with POS 02 and modifier 95 | 99441-99443 with POS 02 There is not a fee increase on these codes | 99381-99397 with 02 and 95 or G0438-G0439 with 02 and 95 | 90 days as of 5/7 | Waived for COVID related visits with a CS modifier through June 1 | FEP plans are NOT COVERED for Video Visits, they must use the Teladoc service |
| Cigna | 99202-99215 with POS 11 and GQ or 95 modifier | G2012 or 99212-99215 with POS 11 and GQ or 95 modifier | 99381-99397 with 02 and 95 or G0438-G0439 with 02 and 95 | Through at least 5/ 31 | Waived for COVID related visits with ICD-10 code and CS modifier through at least 5/ 31 | Any service that is currently on a provider’s fee schedule can be provided virtually. This means that if a provider has a code on their fee schedule today that is reimbursable, they can offer that same service virtually and bill us using the same code |
| Humana | 99201-99215 with POS 11 and modifier 95 | 99201-99215 with POS 11 and modifier 95 | G0438 -G0439 with POS 11 and 95 | Not specified | Waived through the end of the year | At a minimum, we will always follow CMS telehealth or state-specific requirements that apply to telehealth coverage for our insurance products |
| Medicaid | 99202-99215 with POS 11 and the GT modifier | 99441-99443 with CR modifier There is not a fee increase on these codes | 99381-99397 with POS 11 and GT | Not Specified | Waived | |
| Medicare | 99202-99215 with POS 11 and 95 modifier | 99441-99443 or 98966-98968 with CR modifier | G0438 -G0439 with 02 and 95 | Not Specified | Waived for COVID related visits with CS modifier | |
| UnitedHealthcare | 99201-99215 with POS 11 and modifier 95 | 99441-99443 for Medicare Adv plans or 99201-99215 with POS 11 and modifier 95 for all others | 99381-99397 with POS 02 and 95 or G0438-G0439 with 02 and 95 | Through 6/18 | Waived through 6/18 | The policy changes apply to members whose benefit plans cover telehealth services |
All payers require that you be in-network to bill for telehealth.
All payer names in the table above are links to the relevant information on the payer website. Please keep in mind this has been very fluid and is subject to change without notice. We do not get payer emails, so if an insurance carrier sends you an email with changes to any of these programs, please forward that on to me so we get the info ASAP.
Tuesday, May 5, 2020, 3:22 pm EST:
Below is an updated cheat sheet about how several of the major payers are handling Telemedicine. If you have printed a copy of the previous version please replace it with this one.
The biggest change is with Medicare now allowing higher paying codes for telephone only visits and several other payers have followed suit. When using a code based on time, make sure you clearly document the start and end time of a visit. One major point, MRA codes will not be calculated if reported during a telephone only visit, they require face to face interaction, either with an in person visit or with a video visit.
| Phone Code | Time | Medicare Fee (locality 3) |
| 99441 | 5-10 min | $15.06 |
| 99442 | 11-20 min | $29.69 |
| 99443 | 21-30 min | $43.01 |
| G2012 | 5-10 min | $15.42 |
You may notice G2012 and 99441 have the same time and nearly the same fee. They are practically the same code, just one pays $0.36 more than the other:
- G2012 - Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
- 99441 – Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
The addition of the codes 99441-99443 is mainly intended to give us access to codes to use when the phone call runs longer than 10 minutes.
We have also added a column for Annual Wellness Visits/Physicals. We are going to be honest, when we saw physicals start coming in through telemedicine there was a lot of wondering how exactly you could do that. Apparently some of the insurance carriers are wondering too, as not all of them are allowing those visits through Telemedicine. An Annual Wellness Visit for Medicare does not require a physical exam, so that is fine, but for commercial carriers make sure you check with the payer before doing them.
| Insurance | Video Visit | Telephone Visit | Annual Wellness Visit | Timeframe allowed | Cost Share | Other |
| Aetna | 99201-99215 with POS 02 and modifier 95 | 99441-99443 or G2012 with POS 02 | G0438 -G0439 with 02 and 95 | Through 6/4 | Waived | Aetna covers video visits normally; cost sharing is waived through 6/4 |
| BCBS FL | 99201-99215 with POS 02 and modifier 95 | 99441-99443 with POS 02 | 99381-99397 with 02 and 95 or G0438-G0439 with 02 and 95 | 90 days as of 3/20 | Waived for COVID related visits with a CS modifier | FEP plans are NOT COVERED for Video Visits, they must use the Teladoc service |
| Cigna | 99212-99215 with POS 11 and GQ modifier | G2012 with POS 02 | 99381-99397 with 02 and 95 or G0438-G0439 with 02 and 95 | Through 5/ 31 | Waived for COVID related visits with ICD-10 code | Any service that is currently on a provider’s fee schedule can be provided virtually. This means that if a provider has a code on their fee schedule today that is reimbursable, they can offer that same service virtually and bill us using the same code |
| Humana | 99201-99215 with POS 02 | 99201-99215 with POS 02 | G0438 -G0439 with POS 02 and 95 | 90 days as of 3/10 | Waived | |
| Medicaid | 99212-99215 with POS 11 and the GT modifier | 99441-99443 with CR modifier | 99381-99397 with POS 11 and GT | Not Specified | Waived | |
| Medicare | 99202-99215 with POS 11 and 95 modifier | 99441-99443 or 98966-98968 with CR modifier | G0438 -G0439 with 02 and 95 | Not Specified | Waived for COVID related visits with CS modifier | |
| UnitedHealthcare | 99201-99215 with POS 11 and modifier 95 | 99201-99215 with POS 11 and modifier 95 | 99381-99397 with POS 02 and 95 or G0438-G0439 with 02 and 95 | Through 6/18 | Waived | The policy changes apply to members whose benefit plans cover telehealth services |
All payers require that you be in-network to bill for telehealth.
All payer names in the table above are links to the relevant information on the payer website. Please keep in mind this has been very fluid and is subject to change without notice.
Tuesday, May 5, 2020, 9:57 am EST:
As the calendar has flipped to May and the states are starting to look at re-opening it’s time for another series of updates; this first one is going to detail the various codes we are using now, specifically some of the new ones.
Testing
If you are a primary care practice (or other relevant specialty) and have not spoken to your lab rep about the availability of antibody testing, that is a conversation worth having. The availability seems to vary widely.
Depending on what you are reading you may see a variety of new codes for specimen collection (G2023 & G2024) or the testing itself (U0003, U0004, 87635, 86328, 86769); these codes are not for you. Even the specimen collection codes are intended for independent clinical labs, and the others are for the lab actually testing the sample.
If you are collecting samples in your office for COVID-19 testing (either for active infection or antibodies), you code them the same as you would when testing for any other condition. While in most circumstances patients do not see the doctor for a visit like this and a 99212 is billed, if the doctor does a basic physical exam at that visit you can bill a 99213 (or higher). As antibody testing begins to take hold this can be a good revenue stream for your practice, to make it a more billable visit than just a blood draw. Also when the results come in you should consider scheduling a telehealth visit to review the results. If the patient is positive for COVID-19 there is likely plenty to review, however even with a negative patient you could go over their risk factors and things to watch out for going forward. Always make sure you include the correct COVID related diagnosis code from the list below for these visits. Some insurances are waiving cost sharing for COVID related visits but they have to be coded correctly.
For Medicare patients, if your visit is for the purpose of COVID-19 testing or results in a COVID-19 test, it should be billed with a modifier CS so it results in waived cost sharing. Make sure you indicate a big CS on the superbill so we know.
Diagnosis Codes
For patients with a positive diagnosis of COVID-19
- U07.1 – COVID-19, virus identified (this is a new code effective April 1)
- Only to be used when the patient has a confirmed positive or presumptive positive diagnosis
- Do not use when COVID-19 is “suspected”, “possible” “probable” or “Inconclusive”
- If COVID-19 meets the definition of a principal diagnosis for the visit it should be coded first, followed by its manifestations (unless the patient is pregnant, in that case O98.5 would still go first)
For patients with signs and symptoms where a diagnosis has not been established code the appropriate symptom, such as:
- R05 – Cough
- R06.02 – Shortness of Breath
- R50.9 – Fever, unspecified
If a patient has actual or suspected contact with someone who has COVID-19 assign the additional code:
- Z20.828 – Contact with and (suspected) exposure to other viral communicable disease
If a patient has presented for screening but is asymptomatic and the results are unknown or negative:
- Z11.59 – Encounter for screening for other viral disease
If a patient has pneumonia as a result of COVID-19 code both:
- U07.1 – COVID-19, virus identified
- J12.89 – Other viral pneumonia
If a patient has bronchitis as a result of COVID-19 code both:
- U07.1 – COVID-19, virus identified
- Either J20.8 – Acute Bronchitis due to other specified organisms OR J40 – Bronchitis, not specified as acute or chronic
If a patient has a respiratory infection as a result of COVID-19 code both:
- U07.1 – COVID-19, virus identified
- J22 – Unspecified acute lower respiratory infection OR J98.8 – Other specified respiratory disorders
Friday, 4/1/2020, 11:34 am EST:
COVID-19 has impacted all of our daily lives. Even here at Accudata, the normal workday looks completely different than it did just a few weeks ago. Between social distancing guidelines, the state-wide Stay-at-Home order issued by Governor DeSantis, and the looming uncertainty of how long both will last, there is a common fear that many believe their businesses will have to temporarily shut down, with the hopes that the temporary shutdown does not lead to a permanent closure.
We have seen this concern from many of our clients, so we have decided to compile a list of the most commonly needed resources we can help with and/or provide to help your business continue during this time.
We are warning you now: this update is quite lengthy, but it does contain information we believe you will find valuable during this time.
Updated Telehealth Billing Cheat Sheet
Our Billing Manager, Natalie, has created a new Telehealth Billing Cheat Sheet. Please note: this is an updated version of the cheat sheet we emailed out Friday, March 27th.
| Insurance | Video Visit | Telephone Visit | Timeframe allowed | Cost Share | Other |
| Aetna | 99201-99215 with POS 02 and modifier 95 | G2012 with POS 02 | Through 6/4 | Waived | Aetna covers video visits normally; cost sharing is waived through 6/4 |
| BCBS FL
|
99201-99215 with POS 02 and modifier 95 | Unknown | 90 days as of 3/20 | As normal | FEP plans are NOT COVERED for Video Visits, they must use the Teladoc service |
| Cigna | 99212-99215 with POS 11 and GQ modifier | G2012 with POS 02 | Through 5/ 31 | Waived for COVID related visits | |
| Humana | 99212-99215 with POS 02 | 99212-99215 with POS 02 | 90 days as of 3/10 | Waived | Modifier not specified, but 95 is likely required |
| Medicaid | 99212-99215 with POS 11 and the GT modifier | No | Not Specified | Waived | |
| Medicare | 99202-99215 with POS 11 and 95 modifier | G2012 | Not Specified | Provider is allowed to waive | |
| UnitedHealthcare | 99201-99215 with POS 02 and modifier 95 | 99201-99215 with POS 02 and modifier 95 | Through 6/18 | Waived | The policy changes apply to members whose benefit plans cover telehealth services |
All payers require that you be in-network to bill for telehealth.
COVID-19 Diagnosis Codes for use now:
- For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would be appropriate to assign the code 818: Encounter for observation for suspected exposure to other biological agents ruled out.
- For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code 828: Contact with and (suspected) exposure to other viral communicable diseases
Effective April 1 - U07.1, 2019-nCoV acute respiratory disease
All payer names in the table above are links to the relevant information on the payer website. Please keep in mind this has been very fluid and is subject to change without notice (although thus far changes have only been for the better).
Please keep in mind the G2012 telephone visits allow between $10-$15, while the video visits appear to be at the normal fee schedule rate.
Accudata Remote Connect
Having as many employees work from home as possible is one of the first steps to continuing business during this time. We have had quite a few of you already take advantage of our newest service, Accudata Remote Connect (ARC), which allows employees to remotely login to their computer at the office from their computer or laptop at home or anywhere in the world (as long as both machines have power and an internet connection). For many of our clients, this service has allowed their billers and other non-medical staff to continue performing their daily tasks, while cutting down on the number of staff required to work in the office. If you haven’t purchased your ARC licenses yet, you can do so by completing this order form. Turnaround time to get the licenses installed is typically pretty quick; our goal has been to get these licenses deployed to our clients within one business day from the completion of their online order form.
Telehealth
Our clients have also been reaching out regarding a telehealth solution and we have been able to get many set up to begin telehealth visits with their patients. If you do not have a telehealth solution for your office, we are working with a company that is signing up providers for $49/month per provider for 6 months (normally $99) for video chat. If you are interested in this offer, please click the here to begin the enrollment process and to ensure that you are provided with the discounted rate.
Need for Webcam vs. Laptops
Between employees working from home and a large number of providers utilizing telehealth, we have been receiving inquiries about webcams. Because webcams have come under such high demand all over, our vendors are currently out of stock and unable to replenish stock. After searching, the only webcams available right now are costing hundreds, if not thousands, of dollars. We are suggesting that our clients look into substituting a webcam for a new, basic laptop; at the end of the day you may come out cheaper and have more use and versatility. With just a basic laptop and an ARC license, you have the advantage of portability and you are therefore able to conduct your telehealth visits and continue working from any place that has an internet connection. We have heard from clients how helpful telehealth has been and how they plan on continuing to utilize it even after the chaos of COVID-19; this solution will help make that possible.
Please note: our vendor is currently showing ship time estimates for new laptops to be around mid-May. While it has been our experience ship times tend to be quicker than the estimated dates, we cannot promise this and suggest that, if you are considering this option, please contact us to order as soon as possible.
Mobile Superbill
Because of the Stay-at-Home order and offices sending their billers to work from home, we have also had to address the issue of getting superbills from the doctor to the biller. For our Medisoft Network Professional clients, our answer has been for them to begin using the Medisoft mobile app on their mobile devices (whether it be a cell phone or tablet). The app provides a mobile superbill that syncs directly with Medisoft; no more paper superbills to hand off! This has also allowed billers to cut down on their data entry time and some have been grateful for the extra time to work on the practice’s A/R.
If you are interested in any of these solutions, please reach out to us at (954) 746-0399 or help@accudataservice.com. As stated at the beginning of this update, the information above addresses the most common concerns we have received from our clients. If you are experiencing any challenges or have any concerns or questions not addressed, please do not hesitate to reach out to us; our number one goal during this time is to be here and to be a valuable resource for you.
Friday, 3/27/2020, 10:09 am EST:
We have a couple of updates for this morning regarding the new "Keeping Workers Employed and Paid Act" and a cheat sheet for billing telehealth visits.
Keeping Workers Employed and Paid Act
Several clients have expressed concern to us about what dramatically decreasing patient visit counts will mean to their businesses depending on how long this COVID-19 pandemic goes on. We’ve been working on compiling some resources on programs available through the state and federal Small Business Administrations, however the bill that passed the Senate Wednesday night could provide the relief many of us are looking for.
The “Keeping Workers Paid and Employed Act” is a main component of the bill and includes interest free loans with deferred payments to help cover payroll and fixed expenses for small businesses. Even better, it forgives those loans if staffing is maintained through June 30, 2020. Senator Rubio has been leading the fight on this part of the bill and has written a one-page summary that is available here.
In Wednesday’s daily press conference, Secretary Munchin stated that he hopes to have the program up and running by the end of next week through all FDIC lenders. The bill passed the Senate Wednesday night and is expected to pass the House today. The President has indicated he plans to sign it.
You’ll want to check with your accountants on the fine print and tax implications.
Telehealth Billing Cheat Sheet:
With more and more of our clients turning to telehealth visits during this time, we have been getting questions regarding billing for those visits. Our billing manager, Natalie, put together this helpful email for all of her billing clients; we thought it was extremely helpful, so we want to share it with all of you as well.
| Insurance | Video Visit | Virtual Visit - Telephone(G2012) | Timeframe allowed | Cost Share | Other |
| Aetna | 99201-99215 with POS 2 and modifier 95 | Yes | Through 6/4 | Waived | Aetna covers video visits normally; cost sharing is waived through 6/4 |
| BCBS FL
|
99201-99215 with POS 2 and modifier 95 | Unknown | 90 days as of 3/20 | As normal | FEP plans are NOT COVERED for Video Visits, they must use the Teladoc service |
| Cigna | 99241 with POS 11 with no modifier | COVID-19 related only | Through 5/ 31 | Waived if billed with a COVID related ICD-10 code | Directing members to their own Teledoc service for video visits |
| Humana | 99212-99215 with POS 2 | Unknown | 90 days as of 3/10 | Waived for “urgent care needs” | Modifier not specified, but 95 is likely required |
| Medicaid | 99212-99215 with POS 2 and the GT modifier | No | Not Specified | Waived | |
| Medicare | 99212-99215 with POS 2 | Yes | Not Specified | Provider is allowed to waive | |
| UnitedHealthcare | 99201-99215 with POS 2 and modifier 95 | Yes | Through 6/18 | Unknown | The policy changes apply to members whose benefit plans cover telehealth services |
All payers require that you be in-network to bill for telehealth.
COVID-19 Diagnosis Codes for use now:
- For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would be appropriate to assign the code Z03.818: Encounter for observation for suspected exposure to other biological agents ruled out.
- For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code Z20.828: Contact with and (suspected) exposure to other viral communicable diseases
Effective April 1 - U07.1, 2019-nCoV acute respiratory disease
All payer names in the table above are links to the relevant information on the payer website. Please keep in mind this has been very fluid and is subject to change without notice (although thus far changes have only been for the better).
Please keep in mind the telephone visits allow between $10-$15, while the video visits appear to be at the normal fee schedule rate.
We hope this helps you out.
Monday, 3/23/2020, 9:30 am EST:
The Centers for Medicare and Medicaid Services has announced relief for those practicing in the Quality Payment Program in response to COVID-19 pandemic. MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year.
The full press release can be read here and the COVID-19 Medicare Provider Enrollment Relief FAQ page can be found here.
Wednesday, 3/18/2020, 3:00 pm EST:
Over the past week we have been working to deploy new solutions to help our customers face the challenges presented by COVID-19, for instance providing remote access to allow non-medical staff to work from home as well as telehealth solutions for providers. In addition to this, our medical billing team has been keeping us up to date on the latest changes regarding payments for telehealth visits from CMS and private insurance companies.
Please find below a summary of each of these topics as of today at 9:30 am. Please keep in mind that as the days and hours pass we are finding that more and more insurance companies are updating their rules and allowing more flexible and less risky options for patients to seek healthcare.
Telehealth Visits
As of the noon press conference on March 17th, CMS has officially allowed all providers to see patients over telehealth for Medicare patients and recommended that Medicaid and commercial carriers do the same. CMS has provided a Fact Sheet regarding Medicare Telemedicine. The President instructed all patients who have questions about Telehealth to call their doctor’s office.
If you do not have a telehealth solution for your office we are working with a company that is signing up providers for $49/month per provider for 6 month (normally $99) for video chat. It takes 2 – 3 days to sign up right now however we expect the rush of new providers to cause this to increase. If you are interested in this offer, please click the link below and complete the short form to ensure that you are contacted and provided with the discounted rate mentioned above.
Click Here to Request a Call Regarding the Discounted Telehealth Solution
Once you have completed the form you will receive a link where you can learn more about this solution and what it can provide your practice and patients. A team member from our partner will reach out to you shortly to discuss the offer and answer any of your questions.
Remote Access to Work from Home
The public is being asked to avoid gatherings of 10 or more people which has resulted in many companies considering the possibility of having some or all of their employees work from home. In an effort to help our customers provide this to their employees we have launched a solution called Accudata Remote Connect or ARC for short. If this is something that you would like to purchase you can click on the link below to be taken to our online order form.
Click Here to Purchase Accudata Remote Connection Licenses
This will allow you to install our ARC software on your computer in the office and then access that computer from anywhere in the world as long as both machines have power and an internet connection.
Accudata Service Operations
We have already setup many of our employees to work from home to ensure that support operations are minimally impacted by the COVID-19 pandemic and its rapidly evolving restrictions. As always, you can reach us to open a request for service by using any of the following three methods:
- Customer Portal – Click HERE to be taken to the login page. If you have not logged into the new portal then you may have to click on the Sign Up button and complete a short sign up process before you will be able to open and view tickets for your organization.
- Email – You can email help@accudataservice.com for Medisoft software support and it@accudataservice.com for any other type of technical support.
- Telephone – Call us at (954) 746-0399 anytime between 9:00 am and 5:00 pm Monday through Friday to speak directly to a representative or leave a voicemail. We also offer after hours emergency support for an additional fee if you need immediate assistance outside of these hours.
Any of the three methods above will create a support ticket in our ticketing system which will ensure that your issue is addressed. If you use the customer portal, you will also be able to see the status of your ticket and any notes on that ticket from our team.
COVID-19 Guidance for Providers
We have been researching how each carrier will be addressing the COVID-19 pandemic and their coverage for telemedicine visits. Some important take always are that each carrier may be handling this differently, for example, CMS is now paying their providers the full office visit price for a telemedicine visit however others are requiring that patients use their contracted telemedicine providers. This is changing rapidly so we are advising our customers to check with each carrier directly to determine if they will cover the telemedicine visit and how that needs to be billed.
In order to provide as much help as possible, we have included some helpful links below:
General Billing Guidance from CodingIntel
Medicare Guidance for Providers
UnitedHealthcare Guidance for Providers
We are closely monitoring the situation and will be updating this page as things change. For the most up-to-date information from us, please visit our Facebook page.