COVID-19: Interim Guidance
During this time of heightened awareness of the novel Coronavirus, COVID-19, and its classification by the World Health Organization (WHO) as a global pandemic, we want to keep you up to date on how Evernorth Behavioral Health is working to help support you and your covered patients.
Many behavioral providers have contacted us about delivering telehealth sessions. While we have been reimbursing for telehealth since 2017, and will continue to do so post-pandemic, we have made some temporary revisions to telehealth requirements to support continuity of care during this unique situation. The following changes are effective through October 13, 2022, unless otherwise noted.
- As federal guidelines continue to evolve in support of the COVID-19 pandemic, we proactively extended applicable customer cost-share waivers and other enhanced benefits, through February 15, 2021 for treatment and through October 13, 2022 for testing and testing-related services, unless otherwise mandated by the state. This guidance is subject to change.
Individual providers and outpatient clinics
If you are an individual provider or an outpatient clinic, you may use telehealth for outpatient therapy, applied behavior analysis (ABA),* medication management, and Employee Assistance Program (EAP) services. You may offer telephonic sessions to patients who do not have access to technology to participate in telehealth sessions, as appropriate and in accordance with current legislative guidance. Include the following information on your claim form:
- Appropriate Current Procedural Terminology® (CPT®) code in Field 24-D for the service(s) provided
- Modifier 95** in Field 24-D to specify telehealth (see sample claim below)
- Place of Service (POS) 02 in Field 24-B (see sample claim form below)
For illustrative purposes only.
Facilities can render some or all of their services via telehealth (i.e., PHP, IOP, or services that are offered within an inpatient stay such as attending consultations or family therapy sessions), if appropriate. Providers may offer telephonic sessions to patients who do not have access to technology to participate in telehealth sessions, as appropriate and in accordance with current legislative guidance.
Please note: These virtual services will continue to be covered after the pandemic.
- If a facility normally bills services on a UB04 claim form, they must include the following on their claim:
- Appropriate Revenue Code for the service rendered
- Appropriate CPT® or Healthcare Common Procedure Coding System (HCPCS) code for the service rendered
- Modifier 95**
- If routine outpatient services are normally billed on a CMS1500 claim form, the following must be included:
- Modifier 95** in Field 24-D to specify telehealth (see sample claim above)
- 02 in Place of Service in Field 24-B (see sample claim above)
- To provide telehealth services during this interim period, facilities do not need to submit an attestation, nor do they need to change their contracts.
- Prior to rendering services, please call the number on back of the patient’s ID card to verify eligibility and authorization requirements. At this time there are no procedural changes.
- A facility does not need to contact us if telehealth services are being provided to a covered patient who already has an authorization in place. Current authorizations cover telehealth sessions. If a facility has a clinic contract, attestations are not required during this interim period.
Please note: Providers can also use HCPCS code G2012 for a 5-10 minute phone conversation, and Evernorth will waive cost-share for the customer. This will allow for quick telephonic consultations, outside the context of evaluation and management (E&M) services, and will offer appropriate reimbursement for this amount of time. Evernorth will cover code G2012 with no customer cost-share for all services (including non-COVID-19 related services) until further notice.
Covered until further notice, Evernorth will allow eConsults when billed with CPT codes 99446-99452 for all conditions. Evernorth's claim systems are able to accurately process claims with these codes as of May 1, 2020. In addition to the applicable CPT code, providers will need to bill with an appropriate ICD-10 code and POS 02 for virtual services.
Please note: Evernorth does not provide additional reimbursement for PPE-related costs, including supplies, materials, and additional staff time (e.g. CPT code 99072), because office visit (E&M) codes include overhead expenses, such as necessary personal protective equipment (PPE). Separate codes providers may use to bill for supplies are generally considered incidental to the overall primary service and are not reimbursed separately. Contracted providers can’t balance bill customers for non-reimbursable codes.
* Medical Necessity Criteria for the level of care being delivered must continue to be met.
** The "GT" modifier has been retired by the Centers for Medicare & Medicaid Services (CMS), but it still acceptable on claim forms.
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