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  • Asking the Right Questions About Telehealth

    It's not enough to ask if telehealth is permitted by a state agency or payer: You need to ask specific questions to understand what you can and can't do.

    As the coronavirus pandemic worsens, PTs and PTAs are looking for answers around what they can and can't do in terms of telehealth. APTA's advice: Get the right answers by asking the right questions.

    According to Alice Bell, PT, DPT, APTA senior payment specialist, in addition to federal-level changes around digital communications with patients, the telehealth environment is also evolving rapidly at both the private payer and state regulatory levels.

    "Right now, there's a great deal of confusion around the coverage of telehealth when provided by physical therapists," Bell said. "Some broad policies and federal and state legislation may be interpreted as including physical therapists even though this is not explicitly stated."

    Daniel Markels, APTA state affairs manager, says that miscommunication can make matters worse.

    "If a PT calls a payer and asks if telehealth is covered, the payer may say yes not knowing that it's a PT asking the question or what codes the physical therapist intends to bill," Markels said.

    That's why APTA recommends that, besides having a solid understanding of the limitations in state licensure scopes and relevant state and federal laws, PTs ask the following questions when communicating with a payer or state agency about whether telehealth is permitted for physical therapist services:

    • Will services provided by physical therapists (and PTAs working under the direction and supervision of the PT) be covered when provided via telehealth?
    • If so, what codes should be billed and what modifiers are required?
    • What device(s) or application(s) can be utilized?
    • What, if any, consents are required?
    • Are there any special documentation requirements?

    [Editor's note: Official guidance and best practices related to telehealth and e-visits could change rapidly as the COVID-19 outbreak continues to evolve. For the most current information from APTA, see our main Telehealth webpage and visit our APTA.org/Coronavirus/ webpage.]

    Comments

    • There is mounting confusion regarding "telehealth" vs "evisit" On your webinar 3/20/20 it was specifically stated that "video" interactions were not allowed. Now on the APTA's site there are numerous mentions of "video" see this link from APTA site https://www.aptahpa.org/page/COVID19#InteractiveAudio "Your reason for adopting telehealth. Knowing this will help guide your decisions moving forward. For example, if you are adopting telehealth to provide live video visits, then you will look for a telehealth product with live video capabilities as its strength." In addition large PT practices with more than 185 clinics are actively advertising video visits. Too much confusion. Please clarify what can and cannot be done!!

      Posted by Tom Matassa on 3/23/2020 2:43 PM

    • I was on the phone today for 40 minutes with two major commercial payors. The representatives I talked to know nothing about coding, modifiers etc. I asked to speak to a manager and was told that telehealth is being allowed now without any specifics on how to actually get paid for it.

      Posted by Evan Greene on 3/23/2020 6:16 PM

    • Few links shared by CPTA on 3/23/20 include examples from BS in CA: under ancillary services https://www.blueshieldca.com/bsca/bsc/wcm/connect/provider/provider_content_en/guidelines_resources/telehealth-virtual-care CMS on the example code - 97110; https://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=0&HT=0&CT=3&H1=97110&M=5 2020 work RVU's on e-visits (not an official CPT site thus need to verify locally) https://codingintel.com/cpt-codes-online-digital-evaluation-and-management-services/#_ftnref2

      Posted by Alan Lee -> =JQa@L on 3/24/2020 9:03 AM

    • Do we use this new modifier GT in addition to what is already being used and add it on, or do we just bill this modifier alone on all private CPT codes?

      Posted by MELINDA on 3/24/2020 10:01 AM

    • I would second Evan's comment. We have been on the phones for the past few days trying to find answers. Either we are told "we aren't sure at this moment" about coverage, codes, etc. or we are being told it is "different per patient insurance policy". No one is giving clear answers.

      Posted by Cheryl Guarna on 3/24/2020 10:16 AM

    • Frankly, this article, if you can call it that, does not address the most asked question, "has CMS lifted the waiver allowing Physical Therapists to be included in the list of medical professionals being reimbursed for Telehealth services?" and a link to include how to bill for these services. I expect to learn far more information from my documentation vendor's (WebPT) webinar tomorrow at noon than ANYTHING I have seen regarding Telehealth for PTs on the APTA website......this is totally unacceptable. While your live webinar 3/20 on evisits was useful, none of that applies to information re: Telehealth. We, private practice clinics, are desperately in need of daily updates and information! Please Please! do a better job on getting info out to your members/guidance/recommendations/ 'How To"info Kendal Blaser, PT

      Posted by Kendal Blaser on 3/24/2020 10:16 AM

    • Are PT evaluations allowed via Telehealth or are we limited to treating existing patients only?

      Posted by Judy Turner on 3/24/2020 12:25 PM

    • With some states issuing emergency orders (SC) related to the provision of telehealth (beyond e-visits), what is the guidance to PTs in this instance? My understanding is that if it is not approved at the federal level, the state emergency order would not override and the provider would not get reimbursed for providing this service.

      Posted by Kathleen Parisian on 3/25/2020 9:48 AM

    • I am cutting and pasting this from a Medicare notice to Patients: Due to the Coronavirus (COVID-19) Public Health Emergency, doctors and other health care providers can use telehealth services to treat COVID-19 (and for other medically reasonable purposes) from offices, hospitals, and places of residence (like homes, nursing homes, and assisted living facilities) as of March 6, 2020. Coinsurance and deductibles apply.

      Posted by Aviva Gans on 3/25/2020 8:43 PM

    • Does telehealth visits are inclusive on the amount of visits allowed annually? Also, do we need insurance authorization to provide a telehealth service?

      Posted by jOSEPHINE on 3/29/2020 11:08 AM

    • Today I was on phone for about 3-4 hours talking with all the commercial insurances and they said they still are not covering PT for telehealth although it is under consideration. Patients have been calling. We don't know if we should go ahead seeing the patient based on the telehealth information we have received from APTA and other websites or wait till we can get an answer from the insurance company rep which might take a long time.

      Posted by Garima on 3/30/2020 9:10 PM

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