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  • Aetna Now Covers Telehealth Delivered by PTs

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

    UPDATE (April 3): Aetna has advised that telehealth services delivered by physical therapists may be billed on a UB04 using the modifier GT or 95. Please contact advocacy@apta.org with any issues or questions associated with this billing.

    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.

    Check out APTA’s frequently updated telehealth webpage for the latest information on payer and regulatory changes.

    Comments

    • The Aetna website isn't the easiest to navigate does anyone know if they are accepting telehealth claims on the UB-04 form as well as CMS 1500 form?

      Posted by Dave on 4/2/2020 6:17 PM

    • great news that Aetna is following with expanded coverage for telehealth. Would you be able to share a direct link to Aetna's updated reimbursement policy and codes for telehealth? Their site is really hard to navigate and I am finding it hard to find anything related to therapy coverage. Thank you!

      Posted by Laura on 4/3/2020 7:53 AM

    • Aetna in its great wisdom seems to have followed CMS's omission of 97530 in its accepted codes! Hello!? Does anyone out there in the Healthcare Provider world know what we do??? At least THEY are letting PT's use the other 97000-series CPT codes (unlike CMS right now... hoping to change shortly).

      Posted by Paddy Jarit on 4/3/2020 8:04 AM

    • Do you know if this is commercial only or does this include the medicare advantage plans?

      Posted by Billie J McDonald on 4/3/2020 8:41 AM

    • Is this only for receiving services through Teledoc providers or does this cover any in-network provider?

      Posted by Holly on 4/3/2020 8:42 AM

    • Echoing Dave's question... is there information on any and all payors with regards to UB-04 billing with telehealth services? Many payors are asking for POS 02 only without any additional modifiers (e.g. modifier 95 or GT) we do not provide place of service on UB-04 forms...should the 95 modifiers be used in those cases to identify the treatment was provided via telehealth?

      Posted by Dustin on 4/3/2020 8:57 AM

    • I also would like to know if this is commercial only or does this include the medicare advantage plans?

      Posted by Karla on 4/3/2020 9:37 AM

    • I am also curious if Aetna is covering telehealth for facility based billing on the UB-04 form?

      Posted by Jennifer Lyons on 4/3/2020 9:47 AM

    • @Dave: Currently we do not have direction for billing on a UB-04. We have requested this clarification from all payers and at least one has indicated that they are working on adding a new revenue code to accommodate this. We will post more information when we have it. For now it appears limited to the 1500 form.

      Posted by APTA staff on 4/3/2020 10:06 AM

    • I am not locating this on Aetna's website, do you have any links that state this directly from Aetna?

      Posted by Christina OBrien on 4/3/2020 10:28 AM

    • @Laura: Since the provider update is behind a firewall APTA is unable to post a link. The codes they are covering are: 97161, 97162, 97163, 97164, 97110, 97112, 97116, 97535, 97755, 97760, and 97761. Aetna will cover the delivery of the services and procedures described by the codes when delivered by physical therapists and physical therapist assistants via telehealth. When the services are provided by a physical therapist assistant, supervision requirements must be considered. Providers are required to append the GT modifier and must be provided as a two-way synchronous (real time) audiovisual service Additionally Aetna will reimburse physical therapists for the provision of e-visits, virtual check-ins, and telephone services. These services do not require the use of the GT or 95 modifier. E-Visit CPT Codes 98970, 98971, 98972; Store and Forward CPT Code G2010; Virtual Check-in Code G2012; and Telephone Assessment CPT Codes 98966, 98967, 98968.

      Posted by APTA staff on 4/3/2020 10:29 AM

    • @Billie: Since the provider update is behind a firewall APTA is unable to post a link. The codes they are covering are: 97161, 97162, 97163, 97164, 97110, 97112, 97116, 97535, 97755, 97760, and 97761. Aetna will cover the delivery of the services and procedures described by the codes when delivered by physical therapists and physical therapist assistants via telehealth. When the services are provided by a physical therapist assistant, supervision requirements must be considered. Providers are required to append the GT modifier and must be provided as a two-way synchronous (real time) audiovisual service Additionally Aetna will reimburse physical therapists for the provision of e-visits, virtual check-ins, and telephone services. These services do not require the use of the GT or 95 modifier. E-Visit CPT Codes 98970, 98971, 98972; Store and Forward CPT Code G2010; Virtual Check-in Code G2012; and Telephone Assessment CPT Codes 98966, 98967, 98968.

      Posted by APTA staff on 4/3/2020 10:30 AM

    • @Holly: • This covers any in network provider.

      Posted by APTA staff on 4/3/2020 10:30 AM

    • @Dustin: • Currently we do not have direction for billing on a UB-04. We have requested this clarification from all payers and at least one has indicated that they are working on adding a new revenue code to accommodate this. We will post more information when we have it. For now it appears limited to the 1500 form.

      Posted by APTA staff on 4/3/2020 10:31 AM

    • https://www.aetna.com/contentMgt/pws/policies/PDF/telemedicine.pdf This link includes the telehealth policy for Aetna. All billable codes are listed.

      Posted by Shelly on 4/3/2020 11:11 AM

    • Have any providers been able to get into this and how have you done this?

      Posted by Gabe Freyaldenhoven on 4/3/2020 11:34 AM

    • Does it require POS 11 or POS 02

      Posted by Joseph Maccio on 4/3/2020 11:39 AM

    • Did they mention if we have to indicate POS 11 or POS 02?

      Posted by Lindsay on 4/3/2020 11:54 AM

    • What's the difference between 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, 9896

      Posted by Pratik Shah on 4/3/2020 2:34 PM

    • Do we need to change the place of service code to 02 for telehealth?

      Posted by Melissa A Pietraszewski on 4/3/2020 2:40 PM

    • Hi! Do we know if this applies to Aetna Medicare Advantage plans also? Also - should we be using POS: 02?

      Posted by Beth on 4/3/2020 3:05 PM

    • Do you know if Aetna will pay for this if Medicare denies? I know Medicare will not pay for telehealth by PTs. If a client has Aetna secondary to Medicare, can we bypass Medicare and have Aenta pay for the telehealth visit?

      Posted by Melanie on 4/3/2020 3:16 PM

    • @Melanie: We are seeking confirmation from Aetna regarding payment as a secondary insurer. A provider would not be able to bypass Medicare but would submit a claim to Medicare using the GX modifier if an ABN was provided and GY if an ABN was not provided, and submit the claim to Aetna as the secondary once the denial is received from Medicare.

      Posted by APTA staff on 4/4/2020 11:25 AM

    • @Joseph: For telehealth services utilizing the 97000 codes POS is 02. For the e-visit codes POS is 11 if the therapist traditionally bills out of an out-patient clinic and 12 if the therapist operates out of a home office.

      Posted by APTA staff on 4/4/2020 11:26 AM

    • @Lindsay: For telehealth services utilizing the 97000 codes POS is 02. For the e-visit codes POS is 11 if the therapist traditionally bills out of an out-patient clinic and 12 if the therapist operates out of a home office.

      Posted by APTA staff on 4/4/2020 11:26 AM

    • @Pratik: Response: E-visits are non-face-to-face patient initiated communications that occur over a secure online patient portal. They are also assessment and management services and require clinical decision making. Virtual check-ins are quick (5-10 minute) real time communciaitons between a provider and patient that can be done with audio or audio and video. Telephone assessment and management services are patient initiated telephonic communications between patients and providers For more details including how to bill and document these services see the tools on the apta website at http://www.apta.org/Telehealth/ This page is frequently updated as details emerge.

      Posted by APTA staff on 4/4/2020 11:27 AM

    • @Melissa: Aetna has indicated they are following CMS guidance for Medicare Advantage so the 97000 codes via telehealth would not apply for MA. POS 02 should be used for billing the 97000 series codes.

      Posted by APTA staff on 4/4/2020 11:28 AM

    • You indicate in the update that these codes can be billed on the UB04 but in the comments section you indicate that this only applies to the CMS 1500. Could we get clarification?

      Posted by Jordan Spence -> BGRc?L on 4/5/2020 2:28 AM

    • @Jordan: The update was based on new information gathered through our ongoing collaboration with Aetna. 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 advocacy@apta.org with any issues or questions associated with this billing.

      Posted by APTA staff on 4/6/2020 8:49 AM

    • If Aetna is going to be expanding in a way similar to UHC, then providers billing on a UB04 would use revenue code 780 per UHC and BCBS. (along with the modifier.) But this has not been substantiated with Aetna at this time.

      Posted by Morgan on 4/6/2020 3:30 PM

    • What is the place of service we have to use for e-visits??

      Posted by Johanny on 4/8/2020 7:10 PM

    • Is there a listed expiration date of Telehealth coverage for PTs by Aetna?

      Posted by Brian on 4/8/2020 11:54 PM

    • I was also wondering if you have found out if they are using the POS 02 or 11 for PT/OT/ST. Thank you for your help.

      Posted by Angela on 4/9/2020 1:32 PM

    • @Johanny: The place of service for e-visits is 11 if a therapist regularly works out of a clinic and 12 if a therapist regularly works out of his/her home.

      Posted by APTA staff on 4/9/2020 2:00 PM

    • @Brian: As of March 31st Aetna has not indicated an expiration date for coverage of the codes. They have indicated that they are waiving member cost sharing for any covered telemedicine visit regardless of diagnosis until June 4, 2020.

      Posted by APTA staff on 4/9/2020 2:01 PM

    • I see that PT is covered billed on a UB04 claim form, does that also include occupational therapy and speech therapy?

      Posted by Shelia Orlando on 4/13/2020 2:17 PM

    • If I am adding the 95 modifier to a CPT code, does it REPLACE the GP modifier or is in addition to?

      Posted by Debra on 4/13/2020 3:47 PM

    • Aetna is reimbursing at $10 less for telehealth, which violates MN MH Parity Law. Nobody at Aetna can speak to this, do you have any information? How do we make them pay the usual amount?

      Posted by Amanda Westpfahl on 4/14/2020 3:40 PM

    • @Sheila: Yes, that includes OT and ST as well.

      Posted by APTA staff on 4/15/2020 9:47 AM

    • @Debra: Response: Modifier 95 or GT would be used in addition to GP.

      Posted by APTA staff on 4/15/2020 9:47 AM

    • @Amanda: Response: Please contact advoacacy@apta.org so we can provide assistance.

      Posted by APTA staff on 4/15/2020 9:48 AM

    • I was told by Aetna that procedure code 99214 will not be covered for telemedicine but they will cover a "sister code". The representative stated she could not tell me what the code was. Does anyone know the sister code for this?

      Posted by April Spagnolia on 4/15/2020 5:28 PM

    • Any new information regarding billing on UB04 form....revenue code with modifier?

      Posted by Veronica G. Bell on 4/30/2020 3:51 PM

    • What is the end date for Telehealth services for Aetna Medicare patients?

      Posted by Staff on 5/19/2020 3:16 PM

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