It's your responsibility to stay on top of what is and isn't reimbursed, but APTA can help.
APTA and commercial insurers have been receiving questions from PTs whose telehealth-based claims have been rejected, even though the insurer says that in general, they'll reimburse for services delivered remotely. Often the reason for the denial is clear: The provider omitted coding and other information required by the insurer, or used a code for a specific service that the insurer isn't accepting as billable in the first place.
Here's an example: One of the more common reasons for the denials we're seeing at APTA has to do with code 97530 — therapeutic activities. Many payers— including insurance giants Aetna and Cigna—do not include 97530 among the codes that can be billed when delivered via telehealth. PTs who use this code as part of telehealth billing will have their claims denied.
Bottom line: Many of the insurers now allowing telehealth by PTs have rules on which codes can be used, what place of service must be identified, and what modifiers should be added. Those rules must be followed in order to get paid. APTA offers an online resource, updated weekly, that can help you stay on top of the requirements. And be sure to check the payers' websites, too.
Want more on telehealth? APTA's Telehealth webpage helps you keep up with commercial payer requirements and changes at the state level, and connects you with insights from PTs who have been using telehealth long before the current emergency.