TELEHEALTH BILLING & ADMINISTRATIVE GUIDELINES FOR COVID-19

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 CHLA 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. 

Telehealth & Cost-Sharing Coverage Extensions

 

The health plans are extending patient benefits to cover Telehealth visits through:

  • Aetna- December 31, 2020 

  • Anthem/Blue Cross- December 31, 2020

  • Blue Shield- December 31, 2020

  • CIGNA- December 31,2020

  • UnitedHealthcare- October 22, 2020

 
The health plans are extending patient benefits to waive copayments and other cost-sharing for telehealth visits through:

  • Aetna- June 4, 2020 (Behavioral and mental health: September 30, 2020)

  • Anthem/Blue Cross- December 31, 2020

  • Blue Shield- December 31, 2020 (COVID related only)

  • CIGNA-October 31, 2020 (COVID related only)

  • UnitedHealthcare – October 22, 2020 (COVID related only)

Coding Articles and Information

Click here for more information on the CDC's guidelines for coding.

AAP: Using Time As the Key Factor for Evaluation and Management Visits

AAP Telemedicine Coding Fact Sheet

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

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 HIPPA-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

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 HIPPA-compliant or non-HIPAA-​compliant audio-video or audio-only technology for evaluating need for COVID-19 testing.

VISIT

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

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-29 related care without COVID-19 diagnostic testing. 

VISIT

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

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

  • Patient initiates a phone call with physician, nurse practitioner, or physician assistant.

  • 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).

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. A brief check-in with the provider using audio-only with established patient for COVID-19 or non-COVID-19 related care.

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

  • Patient sends a picture for evaluation to a physician, nurse practitioner, or physician assistant.

  • 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).

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

  • Telephone assessment for established patient 

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