Why aren’t telehealth benefits typically included in an eligibility response?
Telemedicine or telehealth benefits are rarely specified in the 271 Eligibility response from insurers. While some categories of benefit carve-outs are often included (such as radiology, physical therapy, and mental and behavioral health), currently the industry has not realized the same adoption for telemedicine.
Many telemedicine benefits are contracted between the telemedicine provider and the employer as an employer-driven benefit. This type of benefit would not appear in a response from an insurer, as it is solely between the employer and employee. To understand benefits for a given patient, the best resource to use is the 270 Eligibility and Benefits verification transaction.
For specifics about telemedicine, questions, and the most up-to-date information, you may follow up with the insurer directly. Many temporary allowances are being made to accommodate the growing need for telehealth coverage as a result of the COVID-19 pandemic. The specifics will vary between different carriers and organizations.
Where can I learn more to help my organization understand telehealth coverage?
Here are some useful resources for understanding changing coverage for telehealth/telemedicine:
- Medicare Telehealth Frequently Asked Questions (FAQs)
- Telehealth Benefits in Medicare are a Lifeline for Patients During Coronavirus Outbreak
- Coverage and Payment Related to COVID-19 Medicare
- American Medical Association Quick Guide to Telemedicine Practice
- EDI Telehealth Resource Guide
- Sirona Strategies’ Policy Update of COVID-19 Related Activity
How can I make sure my organization is staying current with new code updates and changes?
New information is being published frequently in response to COVID-19. Please monitor payer communications and billing guidelines to learn when each payer will be ready to accept and process transactions with the new codes, and for determination of service coverage.
Important updates on COVID-19 codes:
Place of Service Code (Effective January 1, 2017)
Code 02: The location where health services and health-related services are provided or received, through a telecommunication system. Many states and payers are making changes to allow claims billed using the existing Place of Service Code “02” to be paid as if they were an office visit, which is typically billed under Place of Service Code “11”. This change will depend on the entity. Please continue to monitor payer communications and billing guidelines.
New: ICD-10 Diagnosis Code Additions (Effective April 1, 2020)
Used for diagnosis of COVID-19.
Please see: New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), April 1, 2020
New: HCPCS Code Additions
Code U0001: Used by providers and laboratories to bill for laboratory testing of patients for SARS-CoV-2.
Code U0002: Used by providers and laboratories to bill for laboratory testing of patients for COVID-19.
Please see: CMS Fact Sheet: Coverage and Payment Related to COVID-19 Medicare
New: AMA CPT Code Additions
Code 87635: Used for Laboratory testing services that detect the presence of COVID-19, effective immediately.
Please see: New CPT code announced to report novel coronavirus test.
How is Change Healthcare helping customers and partners to address the COVID-19 crisis?
Change Healthcare obtained all code set updates specific to COVID-19 for immediate deployment across all our systems, solutions, and services. Please refer to this page for the latest information.
COVID-19 has dramatically increased the demand for telehealth services as care providers look for ways to manage interactions remotely to reduce the risk of exposure to patients and providers alike. Managing this large influx of patients creates new challenges and the need for new coding and benefit information. Change Healthcare is committed to helping you address these challenges and continuing to deliver the technology and support required for you to continue your business operations efficiently.