COVID-19: Virtual visits and telehealth
At Priority Health, we've long supported telehealth, including phone visits and virtual care.
We've temporarily expanded billable telehealth services
Effective March 26 through June 30, 2020, we'll temporarily allow credentialed providers to bill routine practice codes for services provided through telehealth.
New May 1: We're changing our reimbursement, and aligning to CMS's billing guidance.
- From March 26 - April 30, 2020: We're paying at the standard facility-based rate when billed with a Place of Service 02
- From May 1 - June 30, 2020: We're paying the same rate for telehealth as you're accustomed to receiving for in-person visits
Starting May 1, follow the same process used by CMS to bill for telehealth services. That means you'll bill with the place of service you'd normally use for in-person visits. Add the 95 modifier to identify the visit as telehealth. For Medicaid members, continue to use the GT modifier.
For example, office procedures billed with an evaluation and management (E/M) code of 99201-99215, when performed in real-time by credentialed providers through interactive audio and/or video, can use their standard place of service, add the 95 modifier and receive the non-facility professional payment as of May 1, 2020.
Audio visits also temporarily allowed
We're also allowing for real-time, interactive audio-only telehealth encounters, so you can serve your patients who don't have internet access or audio-visual capabilities.
Facilities (RHC, FQHC, facility-based providers)
Continue to bill as you did prior to COVID-19. When reporting services performed via telehealth, add modifier 95 to these services. For Medicaid, use modifier GT.
- RHC/FQHCs: Use the following codes for virtual visits: G0071, 99421, 99422, 99423, 99441, 99442, 99443, G2012. Modifiers are not required on these codes.
- Distant site telehealth services furnished by facility-based providers, RHC and FQHCs are reported with the appropriate CPT or HCPCS code that falls within their scope of practice and within their fee schedule.
Visits must follow coding guidelines
The visit must follow the guidelines of each code, including the time requirements.
Providers and facilities cannot:
- Use codes that specify in-person or describe services that can only be performed in-person
- Bill for services they are not contracted to provide
- Perform services outside scope of practice, licensure or credentialing
- Bill for a code that requires both an audio and visual component if both audio and visual components are not present throughout the entirety of the visit
Coding guidelines for audio-only visits
As stated above, providers must follow the guidelines of each code. This means that if a code requires both an audio and visual component, providers may not bill this code if an audio-only visit was performed.
If a code does not require both audio and visual and, if in the providers professional judgement, the service can be performed via audio only, then providers may bill this code.
Who can bill for telehealth?
Any credentialed provider or facility can conduct a telehealth visit for all product lines, including commercial group and individual, Medicare and Medicaid.
What's the reimbursement for telehealth?
For existing telehealth codes, we continue to pay the same rates.
For our temporarily expanded codes:
- From March 26 - April 30, 2020: We’re paying at the standard facility-based rate
- From May 1 - June 30, 2020: We’re paying the same rate for telehealth as you’re accustomed to receiving for in-person visits
Your patients' costs
We're covering the cost of virtual care for most members for virtual visit codes: 99441-99443, 99421-99423 and 98970-98972, starting March 19, 2020 through June 30, 2020.
Other codes billed as telehealth will have the member's normal cost share.
Given the government's notification, we're temporarily suspending the requirement for Health Insurance Portability and Accountability Act (HIPAA)-compliant systems. This means if providers do not have a virtual care tool in place, they can use non-public facing tools, like FaceTime, Facebook Messenger video chat, Skype, etc. Providers cannot use public-facing tools like Facebook Live, TikTok or chat rooms, like Slack. All other elements of our medical policy remain in effect, including documentation requirements. See the Office of Civil Rights FAQ for more information.
Care management virtual and phone visits
To support ongoing care management, we've expanded your options. The following codes can be performed via telehealth G9001, G9002, G9007, G9008, 99484, 99490, 99492, 99493, 99494, 99495, 99496, 98966, 98967, 98968.
Make sure to review the other information on this page for information on member cost share, audio-only options, and billing telehealth services.
See our telehealth policy for more information and learn more about billable codes on our virtual visits billing page. Behavioral health providers, see our behavioral health telehealth policy and outpatient billable codes.
For information about how we're covering virtual visits for our members in response to COVID-19, see our provider information page on COVID-19 coverage for our members.
Frequently asked questions: Virtual care
Who can provide virtual visits?
Providers credentialed with Priority Health can provide telehealth services to our members regardless of the member's physical location within Michigan.
How do I bill for virtual visits?
Learn more about billable codes for telehealth and virtual care: telephone visits, e-visits and hosted visits.
I'm a provider who is paid a per-diem rate. Can I bill a telehealth code?
Yes, providers like physical therapists, chiropractors, home health and others can bill for telehealth services, as long as the code billed does not require in-person care.
If I'm not a physician, should I bill under a supervising physician?
All practitioners should continue to bill the same way they always have. If you previously billed under a supervising physician, you should continue to do so.
Can my practice use Skype, FaceTime or other services to offer virtual care?
Yes. Given the government’s notification, we’re temporarily suspending the requirement for HIPAA compliant systems. This means that if you don’t have a virtual care tool in place, you can use non-public facing tools, like FaceTime, Facebook Messenger video chat, Skype, etc. You cannot use public-facing tools like Facebook Live, TikTok or chat rooms like Slack. All other elements of our medical policy remain in effect, including documentation requirements. See the Office for Civil Rights FAQ for more information.
Are modifiers 95 or GT required when billing a telehealth service?
Starting May 1, add the 95 modifier and use your normal place of service to indicate a service was provided via telehealth for commercial and Medicare. Medicaid requires the GT modifier.
Is funding available to help me with telehealth?
The Federal Communications Commission (FCC), using funding from the CARES Act, has a program to help fund telehealth programs for qualifying providers. Get more information.