Telehealth Coverage Expanding

The ongoing COVID-19 pandemic has led many insurance plans to expand their telehealth coverage. Notably, Medicare announced it will remove its limitations on who can provide telehealth services, temporarily allowing nearly all medical providers to bill such charges to a certain degree. Click the below link for a listing of services Medicare covers via telehealth:

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

In Illinois, Governor Pritzker issued an executive order on March 19th to direct all insurances to cover telehealth services with no cost-sharing to the patient. While this order affects Medicaid and some commercial plans, it does not guarantee coverage with self-funded commercial plans. Unfortunately, normally there is no simple way to tell a self-funded commercial plan from a non-self-funded one. However, many self-funded plans have telehealth benefits regardless. As a general rule of thumb, most will approve telehealth visits or consultations. For other services, please make sure to check the patient’s benefits to ensure coverage.

Telehealth charges generally require special modifiers and codes when billed. Accordingly, if you plan on billing telehealth charges or simply have questions about them, please contact our office. When you do provide such services, please indicate telehealth on your billing, as well as whether the visit was performed via an audio only phone call, or via a video conference. For electronic/EHR billing, in addition to selecting the appropriate CPT, append a “GT” modifier to your service to indicate the service was done via telehealth. This will notify us to review the charge and make additional coding changes the payer may require for correct processing.