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COVID-19 Information For Providers

Telehealth, Telemedicine and Technology Based Services

All information contained on this page is applicable only during the declared pandemic time period or other time frames specified below. In the event of any conflict or inconsistency between the information contained on this page and the contents of the UCare Provider Manual, the information on this page shall control during the identified time frame.

PAGE LAST UPDATED JUNE 14, 2021

Eliminating 99201 as a Telehealth Eligible Service

Effective Jan. 1, 2021, 99201 has been deleted and will no longer be an eligible service.

Providers Working from Home – All UCare Products

Effective March 1, 2020, and through the COVID-19 public health emergency, if an eligible provider is furnishing telehealth eligible services from home due to COVID-19 restrictions or for convenience after usual office hours, the address submitted on the claim should be the same as the one the provider customarily uses when submitting claims to UCare. If the provider is performing services from a home-based office that has been enrolled with UCare, then the home-based office address should be submitted on the claim.

Eligible Telehealth Services – UCare Medicare Plans and Individual & Family Plans Products

Eligible Telehealth Providers - Individual & Family Plans

Telehealth professional distant site services can be furnished by the following expanded list of providers:

  • Physician
  • Nurse Practitioner (NP)
  • Physician Assistant (PA)
  • Nurse midwife
  • Clinical Nurse Specialist (CNS)
  • Certified Registered Nurse Anesthetist (CRNA)
  • Licensed Social Worker (LICSW)
  • Licensed Professional Clinical Counselor (LPCC)
  • Licensed Professional Counselor (LPC)
  • Licensed Marriage and Family Therapist (LMFT)
  • Licensed Psychologist
  • Either Masters level or PhD Registered dietician or nutrition professional
  • Effective for claims with a date of service of March 1, 2020, and until the COVID-19 national public health emergency is suspended, UCare will temporarily add physical, occupational and speech therapists to the list of eligible IFP telehealth providers.

Eligible Telehealth Providers - Medicare

UCare will follow current Telehealth guidelines, as well as the temporary CMS Guidance published March 17, 2020 - https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. This includes expanding the definition of originating site to include professional services furnished in all eligible health care settings, and in the patient’s residence. In addition, UCare will follow the temporary guidelines expanding the technology that can be used to furnish an eligible telehealth service.

Effective for claims with a date of service of March 1, 2020, and until the COVID-19 national public health emergency is suspended, the list of providers who are eligible to provide services via telehealth is expanded to include all providers who are eligible to bill Medicare for their services, including, but not limited to physical therapists, occupational therapists and speech language pathologists.

Telehealth Eligible Services

It is UCare’s intent to follow CMS guidelines for our Medicare and Individual and Family Plans products. UCare will add, delete and terminate the use of temporarily available codes for COVID-19 during the national public health emergency based on CMS’ notification and effective dates.

Effective for claims with dates of services March 1, 2021, and through the COVID-19 public health emergency, the following services became telehealth eligible services:

  • 92526 Oral function therapy
  • 92552 Pure tone audiometry air
  • 92553 Audiometry air & bone
  • 92555 Speech threshold audiometry
  • 92556 Speed audiometry complete
  • 92557 Comprehensive hearing test
  • 92563 Tone decay hearing test
  • 92565 Stenger test pure tone
  • 92567 Tympanometry
  • 92568 Acoustic refl threshold tst
  • 92570 Acoustic immitance testing
  • 92607 Ex for speech device rx 1hr
  • 92608 Ex for speech device rx addl
  • 92609 Use of speech device service
  • 92610 Evaluate swallowing function
  • 92625 Tinnitus assessment
  • 92626 Eval aud funcj 1st hour
  • 92627 Eval aud funcj ea addl 15 minutes

Effective Jan. 1, 2021, CMS added the services listed below to the telehealth eligible service list. The most current version of CMS’ telehealth eligible list can be found here.

  • G2212 Prolonged Services

In addition, CMS has identified the status (e.g., permanent, eliminated after public health emergency is suspended) of telehealth eligible services. The most current list of Medicare telehealth eligible service can be found here.

Additional Updates/Clarification

  • Subsequent Nursing Home Visits - The frequency changed from once every 30 days via telehealth to once visit every 14 days.
  • Direct Supervision by Interactive Telecommunications Technology - When required, direct supervision may be provided using real-time, interactive audio and video technology through the later of the end of the calendar year in which the public health emergency ends or Dec. 31, 2021.
  • Appropriate Use of Telehealth Services - Telehealth rules do not apply when the patient and provider are in the same location even if audio/video technology assists in furnishing the service.

Audio-Only Technology

Effective March 1, 2020, and through the COVID-19 public health emergency, CMS defined those telehealth-eligible services that can be furnished without a visual component. Refer to the link above.

Billing and Payment Guidelines for Eligible Telehealth Services – UCare Medicare Plans and Individual & Family Plans Products

Effective for claims with a date of service of March 1, 2020, and until the COVID-19 national public health emergency is suspended, the following guidelines will be temporarily implemented for all telehealth-eligible services:

  • Append the -95 modifier when submitting telehealth eligible services to UCare;
  • Submit telehealth eligible services with the place of service that would have been billed had the service been furnished face-to-face;
  • Place of Service 02 (telehealth) should not be used when submitting claims. If place of service 02 is submitted, payment will be based on the Medicare facility allowed amount; and
  • When providing eligible telehealth Evaluation and Management services via telehealth select the level of service based on medical decision-making or time.
  • Telephone calls (CPT codes 99441, 99442 and 99443) have been added to the list of telehealth-eligible services, and the pricing of these services will be updated to the same amount as CPT codes 99212, 99213 and 99214, respectively. Telephone calls should be used when an E/M service is furnished but no video component of telehealth was used.

Rural Health Clinics (RHC) UCare Medicare products

Rural Health Clinics may bill for telehealth distant site services. Billing guidelines are outlined below:

RHC Claims for Telehealth Services from Jan. 27, 2020, through June 30, 2020

  • Submit telehealth using revenue code 052X;
  • Use revenue code G2025; and
  • Append modifier –CG to the claim. Modifier -95 is optional.

RHC Claims for Telehealth Services starting July 1, 2020

  • Submit telehealth using revenue code 052X;
  • Use revenue code G2025; and
  • Use of modifier -95 is optional. Claims should not be submitted with modifier –CG modifier.

Source: MLN Matters SE20016 Revised

Federally Qualified Health Centers (FQHC)

Federally Qualified Heath Centers may bill for telehealth distant site services. Billing guidelines are outlined below:

FQHC Claims for Telehealth Services Jan. 27, 2020, through June 30, 2020

 Revenue Code  HCPS Code Modifier
 052x G0467 (or other appropriate FQHC Specific Payment Code)  NA
 052X 99214 (or other FQHC PPS Qualifying Payment Code)  95
 052X G2025  95

FQHC Claims for Telehealth Services starting July 1, 2020

  • Submit telehealth using revenue code 052X;
  • Use revenue code G2025; and
  • Append modifier –CG to the claim. Modifier -95 is optional.

Billing Other Technology-Based Services – UCare Medicare Plans and Individual & Family Plans Products

In addition to telehealth services there are other technology-based services that providers may use.

Effective for services starting March 1, 2020, and until the COVID-19 national public health emergency is suspended, the following services are eligible for payment:

 category cpt/hcpcs code narrative description additional information
 Virtual Visits G2010 Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related Evaluation and Management (E/M) service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. Effective March 1, 2020, and through COVID-19 public health emergency virtual visits can be to new and established patients.
 Virtual Visits G2012 Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion. Effective March 1, 2020, and through COVID-19 public health emergency virtual visits can be to new and established patients.
 E-Visits 99421
99422
99423
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days.
 
 E-Visits Use these codes for claims with a dates of service through 12/31/2020

G2061
G2062
G2063

Effective for claims with a date of service 01/01/2021 and thereafter, claims should be submitted using the following codes:

98970
98971
98972

Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days.


 

Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days. 

 
 Telephone Assessments 98966
98967
98968
Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment.  

Billing for Services Provided in an Outpatient Facility – UCare Medicare Plans and Individual & Family Plans Products

Effective for claims with a date of service of March 1, 2020, and until the national public health emergency is suspended, when an eligible outpatient provider employed by the hospital furnishes telehealth eligible services (e.g., physical therapy, occupational therapy, speech language therapy), bill the services as you normally would, and append the -95 modifier to the telehealth eligible service(s) provided.

Facility Telehealth Visits - UCare Medicare Plans and Individual & Family Plans Products

Until the COVID-19 public health emergency is suspended, the service limitations applied to the telehealth services listed below will no longer be applicable:

  • A subsequent inpatient visit (99231-99233) can be furnished via telehealth, without the limitation that the telehealth visit occurs only once every three days;
  • A subsequent skilled nursing facility visit (99307-99310) can be furnished via telehealth, without the limitation that the telehealth visit is once every 30 days; and
  • Critical care consult codes (G0508-G0509) may be furnished by telehealth beyond the once per day limitation.

Critical Access Hospitals (CAH) Method II Distant Site Telehealth Services – UCare Medicare Plans and Individual & Family Plans Products

The requirements for CAH Method II providers have not changed. When distant site services are billed CAH method II providers on an institutional claim, the -GT modifier should be appended to services performed via telehealth.

Eligible Telehealth Services – UCare State Public Programs

UCare will follow DHS Telehealth guidelines.

DHS Coronavirus (COVID-19) Information

Billing and Payment Guidelines for Eligible Telehealth Services – UCare State Public Programs

Effective for claims with a date of service of March 1, 2020, and until the COVID-19 national public health emergency is suspended, the following billing guidelines will be temporarily implemented for all services that are eligible to be furnished via telehealth:

  • Append the -95 modifier when submitting telehealth eligible services to UCare;
  • Submit telehealth services with the place of service that would have been billed had the service been furnished face-to-face;
  • Place of Service 02 (telehealth) should not be used when submitting claims. If place of service 02 is submitted, payment will be based on the Medicaid facility allowed amount;
  • If the video component is inaccessible, the video requirement may be waived (except for those services that are only available with simultaneous video); and
  • When providing eligible telehealth Evaluation and Management services via telehealth all components of an E/M service may be considered, but it is recommended that the level of service be selected based on medical decision-making or time.

Billing Other Technology-Based Services – UCare State Public Programs

Based on DHS guidance UCare will cover the services listed below. Additional information will be provided as it is available.

  • 99441 -Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
  • 99442 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.
  • 99443 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion.

Billing for Services Provided in an Outpatient Facility – UCare State Public Programs

Effective for claims with a date of service of March 1, 2020, and until the national public health emergency is suspended, when an eligible outpatient provider employed by the hospital furnishes telehealth eligible services (e.g., physical therapy, occupational therapy, speech language therapy), bill the services as you normally would, and append the -95 modifier to the telehealth eligible service(s) provided.

Minnesota Health Care Programs (MHCP) Provider Use of the DHS Telemedicine Assurance Statement

UCare State Public Program providers are still required to complete the DHS Telemedicine Assurance Statement. Providers with a previous Telemedicine Assurance Statement (DHS-6806-ENG) on file with DHS and UCare can continue to provide all telemedicine services.

DHS created a new Telephonic Telemedicine Assurance Statement, effective April 1, 2020, through the duration of the coronavirus pandemic. Providers who have not previously completed a Telemedicine Assurance Statement must submit the new Telephonic Telemedicine Provider Assurance Statement (DHS-6806A) to DHS and UCare prior to providing any type of telemedicine services. Organizational providers may submit one form signed by an authorized representative of the organization; along with a spreadsheet of all providers, including their NPI, affiliated with their practice that will be providing telemedicine.

The form should be faxed to UCare at 612-676-6501--ATTN: CLAIMS SUPPORT.

Waiver of 3-Day Service Limits – UCare State Public Programs

Effective for dates of service on and after March 19, 2020, and through the COVID-19 public health emergency the current limitation of three telemedicine encounters per week is temporarily suspended

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