Information on TeleHealth

We are committed to keeping you informed about the telehealth mandate effective January 1, 2016, through our provider newsletter and other communications. This section of our website is intended to provide the most current information and resources available related to telehealth.

The New York state mandate applies to Commercial and Managed Medicaid members. Medicare Advantage members are excluded from this mandate; however, existing Centers for Medicare and Medicaid Services rules apply.

New York state describes telehealth, for purposes of commercial products, as the use of electronic information and communication technologies by a health care provider to deliver health care services to an insured individual while such individual is located at a different site than where the health care provider is located.

New York state describes telehealth, for purposes of Managed Medicaid products, as the use of electronic information and telecommunications technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient. Telehealth includes telehealth, store and forward technology and remote patient monitoring, as specifically defined under the mandate.

It is important to know:

  • Telehealth coverage requirements vary by line of business.
  • Members receiving care by telehealth should understand their financial responsibilities and provide permission before each visit. Standard cost-sharing will apply (deductible, copayments, coinsurances).

What is telehealth? 
Generally, telemedicine is the remote delivery of health care services and clinical information by use of such electronic technology as the Internet, wireless and satellite or the telephone.

What is the NYS telehealth mandate? 
New York became the 22nd state to pass legislation requiring a health plan to provide coverage for services rendered by telehealth that are otherwise covered under a plan when rendered face to face.

When does the mandate go into effect? 
The mandate goes into effect for policies issued, modified or renewed on or after January 1, 2016.

Who is covered by the mandate?  
The mandate provides coverage requirements for Managed Medicaid, all fully insured individual/direct pay and small group (both on and off Exchange) and large group members, as well as Essential Plan and Child Health Plus products.

What is covered by the mandate? 
Existing member benefits when provided appropriately via telemedicine can be reimbursable subject to reasonable utilization management and quality assurance requirements. Coverage requirements vary.

How is the Health Plan fulfilling the terms of the mandate? 
The Health Plan has updated its Telehealth Corporate Medical PolicyOpen a PDF and subscriber contracts to reflect the mandated required changes.

Does the patient need to consent prior to receiving services by telehealth? 
Yes, per our Corporate Medical Policy, the patient must provide consent prior to the telehealth services being rendered. Although, we do not require a written consent form, we are providing an example of a telehealth patient consent form that can be downloaded and adapted to your practice’s needs. Please see the Resources Tab and document titled Example Telehealth Visit Consent for example consent language.

How do I submit and get paid for telehealth services?
Your normal claim process applies to telehealth services. Modifiers GT and GQ are required when the code does not otherwise specify the delivery type.

What technology may I use for telehealth visits? 
Telehealth services must be provided using HIPAA compliant technologies. 

Who should I call if I have questions about submitting claims? 
Questions about claims and billing may be directed to your Provider Relations Representative.

Effective January 1, 2017, CMS will implement a new Place of Service (POS) code 02 for use by the physician or practitioner furnishing telehealth services from a distant site. CMS describes the POS of 02 as “The location where health services and health related services are provided or received, through telecommunication technology.” POS 02 will not apply to originating site facilities who are billing a facility fee. Learn more . . .Open a PDF

Codes not specific to telehealth services should be identified utilizing the following modifiers:

GQ - Via asynchronous telecommunications system

GT - Via interactive audio and video telecommunications system