More commercial insurers are acknowledging that telehealth for PTs isn't just a temporary thing: This week two Pennsylvania-based companies announced that they permanently will include PTs among the providers who can bill for services delivered via telehealth, moving beyond temporary provisions adopted in response to the coronavirus pandemic.
Pennsylvania-based AmeriHealth Caritas and Independence Blue Cross recently issued information on the shift, which will be put in place beginning Jan. 1, 2021. The companies serve a large base within the state — Independence is the largest health insurer in the Philadelphia area, serving about two million people in the region, while AmeriHealth Pennsylvania is a managed care health plan serving 200,000 people across the Lehigh and Northwest regions of Pennsylvania.
- Patients must be established patients.
- The following CPT codes will be covered when the services are provided via telehealth: 97110, 97112, 97116, 97161, 97162, 97164.
- For providers who bill on a UB04, only the following revenue codes will be permitted for telehealth: 0423, 0424, 0429.
- Telemedicine services must take place via a secure HIPAA-compliant telecommunications system using interactive, synchronous (real-time) two-way audio and video communications.
- Providers must report the appropriate modifier (GT or 95) and place-of-service code 02 (Telehealth) to represent telemedicine services.
- For members enrolled in HMO or HMO-POS plans with primary care provider capitation, any capitated services, which include physical therapy, must be referred to the primary care provider's designated capitated sites.
- Applicable member cost-share provisions will be applied.
But be aware: The new policy doesn’t apply to everything. Here are some services that won't be covered if delivered via telehealth beginning on Jan. 1:
- The following codes: 97129, 97130, 97163, 97166, 97167, 97530, 97533, 97535, 97542, 97750, 97755, 97760, 97761, 97129, and 97130.
- Communication technology-based codes (G2010, G2012, G2061, G2062, G2063) and telephone codes (98970, 98971, 98972).
- Services billed under UB04 revenue codes 0420, 0421, 0422, 0424.
Like many commercial insurers, the Pennsylvania-based companies opened telehealth to PTs as a response to the coronavirus pandemic, with positive results. AmeriHealth and Independence aren't the first to make the changes permanent: In May, BlueCross-BlueShield Tennessee was the first to announce a similar change.