American Physical Therapy Association of Delaware

Telehealth Coverage and Billing Pertinent to Delaware

Updated Wednesday, May 27, 2020

Most Recent Information

CIGNA & Telehealth: As federal guidelines continue to evolve in support of the COVID-19 pandemic, Cigna is adopting a position consistent with the federal public health emergency period, which ends on July 24, 2020. As such, Cigna is extending the customer cost-share waivers and other enhanced benefits, including our interim virtual care policy, through at least July 31, 2020.

Q: Will Cigna allow for physical therapists to provide virtual care?

Yes. PT providers can now deliver virtual care for any service that is on their current fee schedule. We have removed the previous guidance that CMS also had to cover the service virtually. PT/OT/ST providers should continue to submit virtual claims with a GQ, GT, or 95 modifier and a face-to-face place of service code (e.g., POS 11).

Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. In these cases, the provider should bill as normal on a UB-04 claim form with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier.

Important notes

  • While we encourage PT providers to follow CMS guidance regarding the use of software programs for virtual care, we are not requiring the use of any specific software program at this time.
  • We maintain all current medical necessity review criteria for virtual care at this time.
  • Our national ancillary partner American Specialty Health (ASH) is applying the same virtual care guidance, so any provider participating through ASH and providing PT/OT services to Cigna customers is covered by the same guidance.

Please see this provision in Gov Carney’s 2nd update to the state of emergency: Governor Carney also temporarily lifted regulations to expand access to telemedicine. Under the modified declaration:

  • Patients do not need to present in-person before telemedicine services may be provided.
  • Delaware residents do not need to be present in Delaware at the time the telemedicine services are provided.
  • Any out of state healthcare provider who would be permitted to provide telemedicine services in Delaware if they were licensed under Title 24 may provide telemedicine services to a Delaware resident if they hold an active license in another jurisdiction.

Now available from APTA: a regularly updated set of resources that track payment and regulatory policies related to the provision of telehealth by PTs The resources exist in five separate files: Federal payer telehealth or e-visit coverage

Highmark BCBS: What telemedicine codes are reimbursable by Highmark? Highmark has temporarily expanded its list of reimbursable telemedicine codes to include procedures that were not previously eligible to be performed via virtual visits and telemedicine. This includes some physical/occupational/speech therapy services (not requiring physical touch by definition) and additional behavior health services. Their Billing policy is explained via this link.

Read more from Highmark regarding telemedicine and virtual visits in their Provide Resource Center.

You can view the temporary Highmark Telecode List here.

Highmark BCBS Delaware has agreed to pay the following codes when Telehealth is provided:

  • 97161
  • 97162
  • 97163
  • 97110

What is the cost to the member?

  • Virtual Visits – All Highmark member cost-sharing (deductibles, coinsurance and copayments) for outpatient virtual visits will be waived from March 13 through June 13, 2020 regardless of medical diagnosis.
  • Telemedicine Services – All Highmark member cost-sharing (deductibles, coinsurance and copayments) for covered services provided by our national vendors, American Well, Doctor On Demand, or Teladoc will also be waived from March 13 through June 13, 2020 regardless of medical diagnosis.

Aetna:  Aetna Now Covers Telehealth Delivered by PTs

Updated: Tuesday, April 14, 2020

Commercial Telemedicine:

  • Non-facility telemedicine claims must now use POS 02.  This is a change from previous guidance provided on April 2nd.  Updates to fee schedules are now complete so that claims with POS 02 will be reimbursed correctly (the same as an office visit)
  • Facilities should continue to use their respective POS; CPTs and the telemedicine modifiers must be noted on UBs as the Rev Code will not be sufficient
  • Claims previously submitted with POS 11 will be reworked internally; you do not need to resubmit claims
  • Claims previously adjudicated which reimbursed at a rate less than the office visit will be reworked; you do not need to resubmit claims
  • Claims that did not apply the $0 cost share will be reworked; you do not need to resubmit claims

Medicare Telemedicine:

  • POS 02 or 11 may be utilized and will reimburse at the same rate
  • Facilities should continue to use their respective Place of Service

Policy is available via Availity.

Aetna joins UnitedHealthcare among the commercial insurers that have expanded coverage from more limited e-visit provisions.

Private insurer Aetna announced that it will now cover a range of services delivered by PTs through telehealth—a significant expansion of its earlier COVID-19-related policy that limited coverage to e-visits. The change comes after APTA engaged in collaborative work with the company to rethink its temporary benefits policy.

The insurer, officially known as CVS Health/Aetna, will cover the telehealth-based delivery of the services and procedures by PTs for CPT codes 97161, 97162, 97163, 97164, 97110, 97112, 97116, 97535, 97755, 97760, and 97761. The telehealth care must be provided as a two-way synchronous (real-time) audiovisual service. Providers are required to append the GT modifier to the codes. Aetna’s expansion follows a similar move by UnitedHealthcare.

Aetna will also continue its policy that reimburses PTs for the provision of e-visits, virtual check-ins, and telephone services. The use of the GT or 95 modifier is not required for e-visit CPT codes (98970, 98971, 98972), the store-and-forward code (G2010), virtual check-in codes (G2012), and telephone assessment CPT codes (98966, 98967, 98968). Visit Aetna’s provider website and follow instructions for accessing detailed policy information on the provider portal.

If the patient is managed by NIA  you won’t need prior auth for the e visit from NIA as those codes are not in their system so NIA is not approving the care. However, Aetna will pay for the e visits.  The provider should send the claims directly to Aetna for the services / codes provided.  

As of 2:00 p.m. on 4/3/2020 Aetna has advised that telehealth services delivered by physical therapists may be billed on a UB04 using the modifier GT or 95. Please contact  with any issues or questions associated with this billing.

Cigna Updates Telehealth Coverage:

CIGNA Updates Telehealth Policy for PT/OT/ST

CIGNA has expanded the list of covered services that PT/OT/ST providers can deliver through telehealth to all codes covered by CMS. Although the addition of these codes by CMS did not impact physical therapists under Medicare as we are not yet eligible providers it does expand covered services under CIGNA as physical therapists are able to bill telehealth services for CIGNA. Covered codes are now:

97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507

Details regarding this change in policy can be found at the link below.

https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html

United Healthcare: UnitedHealthcare will reimburse physical, occupational and speech therapy telehealth services provided by qualified health care professionals when rendered using interactive audio/video technology. State laws and regulations apply. Benefits will be processed in accordance with the member’s plan.

This change is effective immediately for dates of service March 18 through June 18, 2020.

Reimbursable codes are limited to the specific set of physical, occupational and speech therapy codes listed here. UnitedHealthcare will reimburse eligible codes when submitted with a place of service code 02 and modifier 95.

Policy summary below: Outpatient PT/OT/ST codes included as part of the temporary expansion of telehealth services as a result of the COVID-19 public health emergency. This change is effective immediately for dates of service March 18 through June 18, 2020.

Physical therapy evaluation: 97161/97162/97163

Physical therapy re-evaluation: 97164

Physical therapy procedures:

  • 97110: Therapeutic procedure, one or more areas, each 15 minutes
  • 97116: Gait training
  • 97530: Therapeutic activities, one-to-one patient contact, each 15 minutes
  • 97112: Therapeutic procedure, one or more areas, each 15 minutes
  • 97535: Self-care/home management training, each 15 minutes

Billing

E-Visits Points of Clarification to APTA from CMS

  • E-Visits require the GP modifier to be affixed to the E-Visit code (G2061, G2062 or G2063)
  • Part B Private Practices (use HIC 1500) add the CR modifier after the GP
  • Rehab Agencies (use the UB-04) add both the CR and DR modifiers

**Note it might be prudent to call your MAC to confirm their procedure.

E-Visits – Billing

  • Do not use Place of Service (POS) code 02 as this is reserved for  telehealth visits. E-Visits POS should be billed to reflect the location of the billing practitioner. Either 11 for the clinic or 12 for the home.
  • Use the CR (catastrophe/disaster related) modifier with the E-Visit CPT code billed. At  this time, we do not know if the GP, GO or GN (professional designation codes) should also be affixed to the claim and are still uncertain as whether Rehab Agencies have to add the DR modifier in place of the CR modifier or in addition to the CR modifier. CMS updated MLN SE20011 to eliminate the CR and DR on telehealth but did not note if this applied to E-Visits. If possible, please do not call or email BCMS about this matter as we will post this information in SIPA as soon as we can get the question answered.
  • Physical Therapist Assistants are not permitted to perform E-Visits according to the information we have as of this date.
  • Seven Day Period:
    a.   Begins on the first E-Visit
    b.   End on the 7th calendar day from the initial E-Visit (includes the E-Visit date)  – – Example: First visit March 23, 2020 last date that an E-Visit can occur would be March 29, 2020.
  • Billing for the E-Visit should occur on or after the 7th day of the E-Visit period.
  • Time should be documented for each E-Visit and the Grand Total of minutes should be documented and billed using one of the following: G2061, G2062 or G2063.
  • No more than one G2 code can be used in the 7-day period; we do not know at this time if a provider can utilize additional 7-day period billing in the same episode of care.