The following information is meant to assist you in providing chiropractic care and ease of access to our members during the COVID-19 State of Emergency.
On March 20, 2020, a bulletin was sent to all participating providers regarding enhanced reimbursement for telehealth telephone and online evaluation services provided to commercial and Medicare members during the COVID-19 State of Emergency (secure login required to access the March 20th bulletin).
The intent of this information is to respond to questions unique to chiropractic practices.
Billing Information for Chiropractic Telehealth Services
Providers rendering telehealth services that meet the criteria for a new patient office evaluation and management (E/M) service (i.e. 99201-99205) should bill the office E/M code with place of service 02. These codes will be reimbursed at the same rate as if performed face-to-face in the office setting and will not be subject to member cost-share (i.e., copay, coinsurance, deductible).
If telehealth services need to be provided to an established patient during the State of Emergency such as an assessment for lower back pain, you may bill either one of the telehealth telephone call or online evaluation codes noted in the March 20, 2020 bulletin.
Since Excellus BlueCross BlueShield does not reimburse chiropractors for office evaluation and management services provided to established patients (i.e. 99211-99215), these codes remain non-covered.
At this point in time, when telehealth is a covered benefit, telehealth visits are covered for all medically necessary diagnoses (not just those related to COVID-19) with no member cost-share until the State of Emergency has been lifted. Telehealth services must be submitted with place of service (POS) code 02, as well as any appropriate telehealth modifiers (e.g., GT, GQ, 95).
Telehealth services are covered under all product lines, although there is some variation in covered codes for Medicare Advantage.
Telehealth is for medically necessary care (acute, subacute) provided to patients under your care during the State of Emergency, or for new musculoskeletal conditions/exacerbations that may arise. Please note that normal/customary documentation standards remain in effect.Email this article