Contracted MAHP & Health Choices Providers:
MAHP and Health Choices are pleased to partner with you, our contracted providers, as the COVID-19 pandemic continues. Our common goal remains the same — the health and safety of your patients and our Members.
All medically necessary telehealth (virtual) visits for members of our fully-insured Commercial Group Plans will be allowed in parity with in-person services through October 31, 2021.
While MAHP previously waived cost share on eligible telehealth services when provider offices were closed and in-person services were restricted, this waiver expired on September 30, 2020. Members of our fully-insured Commercial Plans may now choose between in-person or telehealth visits, with identical benefits and standard cost share for In-Network Providers.
For Medicare beneficiaries covered by MAHP’s Cost Plan, telehealth visits will be a covered benefit pursuant to Medicare guidelines for the duration of the Public Health Emergency, or as otherwise permitted by CMS.
MAHP previously waived cost sharing for medically necessary inpatient treatment for COVID-19 furnished by In-Network Providers, but this waiver has now expired. COVID-19 treatment is covered pursuant to the standard terms and conditions of the Member’s Plan.
For Employer Medical Plans administered by Health Choices, please call to verify whether cost share applies to inpatient treatment for COVID-19.
What are eligible telehealth services?
- 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 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.
Who are eligible telehealth practitioners?
Eligible practitioner include physicians, nurse practitioners, physician assistants, or certified nurse midwives. Other practitioners – such as certified nurse anesthetists, license clinical social workers, clinical psychologists, and registered dietitians or nutrition professionals – may also furnish services within their scope of practice.
Do you have billing guidance?
- 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 Commercial telehealth (video and audio) claims, Providers should utilize Place of Service (POS) code 02-Telehealth on the claim, unless it is a Critical Access Hospital (CAH). For Commercial telephone or audio-only check-ins, Providers should not utilize POS code 02, but should bill with the place of service from which the Provider called the patient (such as 11 or 22).
- 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.
- MAHP will reimburse 100% of the Medicare Allowable for telehealth services for Medicare Cost Plan Members during the emergency period. For telehealth services provided after March 1, 2020, Providers should utilize Modifier 95.
- 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 these Medicare telehealth guidelines.