CHLA CARE NETWORK
TELEHEALTH BILLING & ADMINISTRATIVE GUIDELINES FOR COVID-19
Telehealth & Cost-Sharing Coverage Extensions - Updated September 26, 2022
Aetna:
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Aetna is waiving cost sharing for COVID-19 testing.
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Aetna is NOT waiving cost sharing for COVID-19 related telehealth or treatment visits.
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For telehealth services, continue to bill POS-02.
Anthem
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Anthem is waiving cost sharing for COVID-19 testing and COVID-19 related telehealth visits.
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Anthem is NOT waiving cost sharing for COVID-19 treatment visits.
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For telehealth, bill either POS-02 or POS-10 (when patient is at home).
Blue Shield
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Blue Shield is waiving cost sharing for COVID-19 testing.
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Blue Shield is NOT waiving cost sharing for COVID-19 related telehealth or treatment visits.
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For telehealth, bill either POS-02 or POS-10 (when patient is at home).
CIGNA
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CIGNA is waiving cost sharing for COVID-19 testing and COVID-19 related telehealth visits until 1/15/22.
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CIGNA is NOT waiving cost sharing for COVID-19 treatment visits.
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For telehealth, CIGNA commercial is asking providers to continue to bill with a typical face-to-face place of service (e.g., POS 11) and append with GQ, GT, or 95 modifier as needed.
United Healthcare (UHC)
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UHC is waiving cost sharing for COVID-19 testing.
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UHC is NOT waiving cost sharing for COVID-19 related telehealth or treatment visits.
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For telehealth, bill either POS-02 or POS-10 (when patient is at home).
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Coding Articles and Information
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Click here for more information on the CDC's guidelines for coding.
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AAP: Using Time As the Key Factor for Evaluation and Management Visits
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Aetna only: these are telephone only codes and do not equate to an office visit, so they will not result in an office visit reimbursement rate
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The following scenarios are intended as a guide to help you understand how you are to bill each of the insurance plans contracted under the Care Network CHAMPS agreement. Please be sure that you submit accurate claims in accordance with state and federal laws, as well as the policies for each insurance plan. These scenarios do not capture all possibilities but should give you an idea of how to bill during the COVID-19 pandemic.
Please be advised that patient code "99201" was deleted on January 1, 2021.
Please be advised that all e-visits and phone visits require time documentation.
TELEHEALTH SCENARIO 1: Establish patient visit with a provider who uses an audio - video or audio - only telecommunications system for COVID-19 or non-COVID-19 related care.
PATIENT SCENARIO
Established patient presents for a telehealth visit using HIPAA-compliant or non-HIPAA-​compliant audio-video or audio-only technology for COVID-19 or non-COVID-19 related care not resulting in COVID-19 diagnostic testing.
VISIT
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Scheduled or same day telehealth visit with an established patient
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Care is delivered by a physician, nurse practitioner or physician assistant
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TELEHEALTH SCENARIO 2: Established patient visit with a provider who uses an audio-video or audio-only telecommunications system for evaluating need for COVID-19 testing.
PATIENT SCENARIO
Established patient presents for a telehealth visit using HIPAA-compliant or non-HIPAA-​compliant audio-video or audio-only technology for evaluating need for COVID-19 testing.
VISIT
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Scheduled or same day telehealth visit with an established patient
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Care is delivered by a physician, nurse practitioner or physician assistant
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TELEHEALTH SCENARIO 3: Established patient with COVID-19 diagnosis visits with a provider who uses an audio-video or audio-only telecommunications system.
PATIENT SCENARIO
Established patient who has been confirmed positive for COVID-19, presents for a telehealth visit using HIPAA compliant or non-HIPAA-compliant audio-video or audio-only technology for COVID-19 related or non-COVID-19 follow-up care.
VISIT
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Scheduled or same day telehealth visit with a patient that you have seen in the past three years
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Care is delivered by a physician, nurse practitioner or physician assistant
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TELEHEALTH SCENARIO 4: New patient visit with a provider who uses an audio-video or audio-only telecommunications system for COVID-19 or non-COVID-19 related care.
PATIENT SCENARIO
New patient presents for a telehealth visit using HIPAA-compliant or non-HIPAA-compliant audio-video or audio-only technology for COVID-19 or non-COVID-19 related care without COVID-19 diagnostic testing.
VISIT
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Scheduled or same day telehealth visit with a patient that you have seen in the past three years
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Care is delivered by a physician, nurse practitioner or physician assistant
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TELEHEALTH SCENARIO 5: New patient visit with a provider who uses an audio-video or audio-only telecommunications system for evaulating need for COVID-19 testing.
PATIENT SCENARIO
New patient* presents for a telehealth visit using HIPAA-compliant or non-HIPAA-compliant audio-video or audio-only technology for evaluating need for COVID-19 testing.
VISIT
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Scheduled or same day telehealth visit with a patient that you have seen in the past three years
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Care is delivered by a physician, nurse practitioner or physician assistant
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ELECTRONIC VISIT (E-VISIT) SCENARIO 1: Communication between an established patient and their provider through an online patient portal for COVID-19 or non-COVID-19 related care.
PATIENT SCENARIO
Established patient sends message (e-visit) through the online patient portal or some other secure platform (e.g. MyChart).
VISIT
Patient initiates an e-visit on an issue through the provider's online patient portal to a physician, nurse pratitioner or physician assistant.
VIRTUAL CHECK-IN SCENARIO 1: A brief check-in with the provider using audio-only with established patient for COVID-19 or non-COVID-19 related care.
PATIENT SCENARIO
Established patient connects for a brief check-in by audio only (virtual check-in).
VISIT
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Patient initiates a phone call with physician, nurse practitioner, or physician assistant.
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Issue is not related to a medical visit within the previous 7 days and not resulting in a medical visit within the next 24 hours (or soonest appointment available).
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VIRTUAL CHECK-IN SCENARIO 2: 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 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.
PATIENT SCENARIO
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.
VISIT
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Patient sends a picture for evaluation to a physician, nurse practitioner, or physician assistant.
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Issue is not related to a medical visit within the previous 7 days and not resulting in a medical visit within the next 24 hours (or soonest appointment available).
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TELEPHONE ASSESSMENT: A telephone assessment and management service provided by a physician or other qualified healthcare professional to establish a patient, parent or guardian not related to E/M service provided within the past seven days or leading to an E/M service or procedure within 24 hours or the soonest available appointment.
PATIENT SCENARIO
Telephone assessment and management service by a physician or other qualified healthcare professional to establish a patient, parent or guardian not related to E/M service provided within the past seven days or leading to an E/M service or procedure within 24 hours or the soonest available appointment.
VISIT
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Telephone assessment for established patient
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