by Carol Hoppe, CPC, CCS-P, CPC-I
MedLucid Solutions, LLC

As of June 8, there have been several updates from payers on extension of dates for telehealth services code changes, as well as other interesting issues from a billing and coding perspective. Most of this information is straight from the payer websites. 

Anthem policies extended through Sept. 13
Cost-sharing for telehealth in-network visits will be waived from March 17 through Sept. 13, 2020, including visits for behavioral health; for fully-insured employer, individual and Medicare Advantage plans; and, where permissible, Medicaid. Self-funded customers are encouraged to participate, and these plans will have an opportunity to opt in. The cost-sharing waiver includes copays, coinsurance and deductibles, as well as FDA-approved medications or vaccines when they become available. Read more here. 

UHC summary of COVID-19 dates
The UnitedHealthcare (UHC) Summary of COVID-19 Dates by Program outlines the beginning and end dates of the program, process or procedure changes that UnitedHealthcare has implemented as a result of COVID-19. Full details of these changes, including applicable benefit plans and service information, can be found here.
   
Please be aware of the following key dates:

June 1: All currently effective prior authorization requirements and site of service reviews resume.

June 30: Claims with a date of service on or after Jan. 1, 2020, will not be denied for timely filing if submitted by June 30, 2020.

July 24: COVID-19 telehealth service coverage and related cost-share waivers for individual and fully insured group market health plan members are extended through July 24, 2020. Adhere to state regulations for Medicaid plans.

Sept. 30: Cost share is waived for Medicare Advantage members for both primary and specialty office care visits, including telehealth, through Sept. 30, 2020. Read more here. 

Locum tenens rules extended for PHE
CMS has extended the 60-day limit for substitute billing arrangements (locum tenens) “to allow a physician or physical therapist to use the same substitute for the entire time he or she is unavailable to provide services during the COVID-19 public health emergency (PHE), plus an additional period of no more than 60 continuous days after the public health emergency expires. On the 61st day after the PHE ends (or earlier if desired), the regular physician or physical therapist must use a different substitute or return to work in his or her practice for at least one day in order to reset the 60-day clock. Physicians and eligible physical therapists must continue to use the Q5 or Q6 modifier (as applicable).”

 The CR modifier should be used starting on the 61st continuous day. See MLN Matters SE20011. 

Medicare covers 99211 for collecting COVID-19 test
According to the Interim Final Rule CMS-5531-IFC, CMS is allowing CPT code 99211 for the purpose of a COVID-19 assessment and specimen collection for both new and established patients. “This policy will allow physicians and practitioners to bill for services provided by clinical staff to assess symptoms and take specimens for COVID-19 laboratory testing for all patients, not just established patients.” Services provided by clinical staff must meet all “incident to” requirements. CMS is temporarily allowing the direct supervision requirement to be met through the virtual presence of the supervising physician or practitioner using interactive audio and video technology for the duration of the PHE (85 FR 19245). Read more here. 

Watch ISMA’s e-Reports and email updates for additional billing and coding news during the COVID-19 public health emergency.