Please refer to the following link for Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 public health emergency: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html.
Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant.
Telehealth can provide many benefits for your practice and your patients, including increased
access to care and convenience. Many health care providers may be able to provide telehealth visits for a variety of care needs, including routine medical care, urgent care or pandemic-related visits that may otherwise take place an urgent care center or emergency department.
As a participating provider, you can be reimbursed for telehealth when services are provided to members enrolled in the following lines of business:
- Commercial: traditional indemnity, HMO, PPO, EPO and point-of-service products, and policies offered on and off of the New York State of Health
- Medicare: Medicare, Medicare Advantage (PPO/HMO), Medicare Part D
- New York State Government Programs*: Medicaid Managed Care (MMC), Health and Recovery Plan (HARP), and Child Health Plus (CHP)
- MMC: HMOBlue Option, Blue Choice Option, Premier Option
- HARP: Blue Option Plus, Premier Option Plus
- CHP: Child Health Plus, Premier Child Health Plus
- Special Programs*: Healthy NY and the Essential Plan
* The term “Safety Net” refers to the combination of New York State Government Program products and Special Program products
Please refer to the member’s benefits for specific contract benefits and limitations, including member cost-sharing responsibility (e.g., copay, deductible, coinsurance) before rendering telehealth and telemedicine services. Coverage varies by line of business, and coverage limits apply just as they do for similar services provided in a face-to-face setting.
Review our Corporate Medical Policy No. 1.01.49 – Telemedicine and TelehealthOpen a PDF for additional information.
Our members receiving care via telehealth must provide consent prior to a telehealth visit. We do not require a written consent form, but patient consent must be documented in the patient’s medical record.
- New York State Office of Mental Health
- New York State Department of Health
- Centers for Medicare & Medicaid Services (CMS) Telehealth Sheet
- CMS Telehealth Coverage List During the Public Health Emergency
- CMS Medicare Learning Network - Medicare Fee-For-Service Response to the Public Health Emergency on the Coronavirus (COVID-19)
- New York State Office of Addiction Services and Supports
Along with the appropriate CPT® or HCPCS code, the appropriate modifier should be billed, when applicable.
Modifier G0 (zero) may also be reported for telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke.
|95||Synchronous telemedicine service rendered via real-time interactive audio and video telecommunication system||Modifier "95" may only be appended to the specific services listed in Appendix P of the AMA's CPT code book. The CPT codes listed in Appendix P are for services that are typically performed face-to-face but may be rendered via a real-time (synchronous) interactive audio-visual telecommunication system.|
|GT||Via interactive audio and video telecommunication systems||Modifier "GT" is only for use with those services provided via synchronous audio and video for which modifier "95" cannot be used.|
|GQ||Via asynchronous telecommunications system||Modifier “GQ” is used for services delivered via an asynchronous telecommunications system.*
*During the COVID-19 public health emergency, New York state has re-purposed this modifier to identify Medicaid covered services performed via audio only (telephone).
Place of Service (POS) Coding
Services billed on a form CMS-1500 should be reported using POS 02**.
**Note: During the COVID-19 public health emergency, CMS has instructed providers to report the POS code where the provider is located. For example, POS 11 should be reported when the provider is office-based and POS 12 when the provider is home-based. Any applicable modifier should also be reported. Services billed on a UB-04 should be reported using revenue codes 780 – 789, along with the applicable CPT/HCPCS code and modifier, if appropriate.
Please refer to our Code Guidance for the Most Common Telehealth ServicesOpens a pdf for a list of the top services provided via telehealth. It’s important to note that this is not a complete list of all possible services provided via telehealth. The list represents the most commonly billed telehealth services based on claims submitted to the Health Plan.