Contracted MAHP & Health Choices Providers:
May 27, 2020
MAHP and Health Choices remain pleased to partner with you, our contracted providers, in responding to the COVID-19 emergency and making “telehealth” services available for your patients. During this time of emergency, our goals are the same: facilitate access to care without the need of travel and help prevent the spread of COVID 19.
Note: Recent updates are in red.
COVID-19 Treatment: MAHP will waive cost sharing through August 31, 2020, for all medically necessary and clinically-appropriate treatment for COVID-19 furnished by In-Network Providers to members of our fully-insured Commercial groups.
Telehealth Services: All medically necessary and clinically-appropriate “telehealth” (virtual) visits will be allowed.
- For Medicare beneficiaries, CMS defines eligible telehealth under the new Families First Act as:
(i) interactive, real-time audio and video telecommunications;
(ii) brief, virtual check-ins via telephone or other device; and
(iii) e-visits through an online patient portal.
- For Commercial & Health Choices Plans, eligible telehealth services will include all video, electronic or telephonic methods. Practitioners are encouraged to conduct virtual visits through real-time, interactive audio and visual technology, if possible. For those patients without supporting technology, audio only, online patient portal, or secure e-mail or messaging will be reimbursed when delivered in accordance with accepted health care practices and standards. Telehealth services will be covered through August 31, 2020, and then coverage will be reassessed based on the status of the emergency.
Eligible Practitioners: An eligible Practitioner is a physician, nurse practitioner, physician assistant, or certified nurse midwife. Other practitioners – such as physical therapists, occupational therapists, speech therapists, certified nurse anesthetists, license clinical social workers, clinical psychologists, and registered dietitians or nutrition professionals – may also furnish services within their scope of practice.
Reimbursement: MAHP and Health Choices will reimburse 100% of the normal allowable fee for telehealth services for Commercial members and 100% of the Medicare Allowable for Medicare Cost Plan Members during this emergency period. For services that have different rates for office versus facility (the site of service payment differential), CMS updated guidance from 4-3-20 provides that Medicare will use the non-facility payment rate when services are furnished via telehealth. MAHP and Health Choices will follow this Medicare telehealth guideline.
Billing (updated per CMS guidance on April 3 & April 7, 2020):
- For all claims for COVID-19 testing-related charges, Providers should utilize Modifier CS. Services that lead to either an order for OR administration of a COVID-19 lab test are not subject to co-pay or deductible charges. Modifier CS should be added to the physician/practitioner service to allow the claim to process without co-pay or deductible.
- For all Medicare telehealth services provided after March 1, 2020, Providers should utilize Modifier 95 on the claim to indicate the service furnished was actually performed via telehealth.
- For Commercial claims, Providers should utilize Place of Service (POS) code 02-Telehealth on the claim, unless it is a Critical Access Hospital (CAH).
- For a CAH, telehealth should be billed under CAH Method II, which requires the GT modifier. If telehealth is furnished for diagnosis and treatment of an acute stroke, the G0 modifier is required
Cost Sharing: MAHP will waive cost sharing on telehealth visits with In-Plan Practitioners until August 31, 2020 and reevaluate the status of the emergency at that time.
For Employer Group Medical Plans administered by Health Choices, telehealth is an eligible service; however, Participant cost sharing may apply to telehealth visits under a Plan. To verify coverage, please call Health Choices at (866) 390-3872.