COVID-19: Virtual visits and telehealth
Last updated: May 11, 2021
At Priority Health, we've long supported telehealth, including phone visits and virtual care.
We're updating our telehealth billing process and policy
Billing for telehealth services
As we continue to evolve our response to COVID-19, we're transitioning back to our normal billing process for telehealth but will continue to reimburse at the higher non-facility rate. Starting March 1, 2021, you can return to submitting your telehealth billing with the correct site of service code (02). Commercial billing no longer requires the GT and 95 modifiers for professional services.
Telehealth policy changes
We're also expanding the list of services that are payable when done using telehealth. This change is being made because more providers are offering more telehealth services to ensure patients get the care they need during COVID-19. Our updated list follows recommendations from the American Medical Association, CMS and MDHHS for care that is safe and effective via telehealth.
Not all services are covered when provided by telehealth. The codes we cover are those that are medically appropriate and can be accomplished as described by the code being used. For example, preventive medicine visit (codes 99381-99397) may not be suitable for telehealth because age and gender exam elements required for these services can't be accomplished through telehealth methods. In addition, urgent care is no longer a covered telehealth service.
This policy applies to all product lines, including commercial group, individual, Medicare and Medicaid.
Telehealth billing and reimbursement
For existing virtual care codes, we'll continue to pay the same rates paid prior to the COVID-19 pandemic. For expanded telehealth codes:
- From Mar. 26, 2020 - Apr. 30, 2020: We paid at the standard facility-based rate. Bill with a Place of Service 02.
- From May 1, 2020 - February 28, 2021: We're paying the same rate for telehealth as you're accustomed to receiving for in-person visits (using the 95 modifier to identify the visit as telehealth, or the GT modifier for Medicaid). Providers who bill using the Place of Service 02, instead of the 95 or GT modifier, will be reimbursed at the standard facility-based rate.
- Starting Mar. 1, 2021: We're transitioning back to our normal billing process for telehealth but will continue to reimburse at the higher non-facility rate. Starting Mar. 1, 2021, you can return to submitting your telehealth billing with the correct site of service code (02). Commercial billing no longer requires the GT and 95 modifiers.
Facilities (RHC, FQHC, facility-based providers)
Continue to bill as you did prior to COVID-19. Use a GT or 95 modifier to indicate facility services were done via telehealth.
- RHC/FQHCs: Use the following codes for virtual visits: G0071, 99421, 99422, 99423, 99441, 99442, 99443, G2012.
- 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. Effective July 1, retrospective to Jan. 27, 2020, G2025 can be billed for distance services.
Telehealth coding guidelines
Visits 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
You can bill real-time, interactive audio-only telehealth visits that have been requested by the patient, so you can serve your patients who don't have internet access or audio-visual capabilities.
Effective Jul. 1, 2020, all audio-only visits must be billed using audio-only visit codes (99441 - 99443, 98966 - 98968). No other codes can be billed for audio-only visits for commercial and Medicaid members. You should bill for these visits using the place of service you normally would, based on your office location.
For Medicare members, additional codes are accepted. See CMS's list of services that can be provided using audio only.
Given the government's notification, we're temporarily suspending the requirement for Health Insurance Portability and Accountability Act (HIPAA)-compliant systems through the end of the public health emergency. 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.
Telehealth guidelines for behavioral health code 97153
We're temporarily allowing CPT code 97153, direct line (1-to-1) therapy, to be used for telehealth services. Consider the following to determine if your patient meets the guidelines for use of code 97153 for telehealth.
Your patient can:
- Independently sit at a computer for 10-12 minutes
- Follow one to two-step instructions
- Engage in sessions with limited in-person assistance
- Minimally engage in challenging behaviors and a caregiver is present to intervene
Other factors to consider
- Sessions are primarily conversation based
- Caregivers are present during telehealth sessions: Caregivers must be available to intervene as requested by behavior technician and will need to be able to manage token economy systems, prompting member as requested by behavior technician, and deliver reinforcers
Expectations have not changed regarding medical necessity criteria or the authorization process. We don't require additional authorization to provide telehealth services. If you have any questions, please contact the Behavior Health Department at 1.800.673.8043.
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 through the end of the public health crisis. 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 March 1, 2021: We're transitioning back to our normal billing process for telehealth but will continue to reimburse at the higher non-facility rate. Starting March 1, 2021, you can return to submitting your telehealth billing with the correct site of service code (02). Commercial billing no longer requires the GT and 95 modifiers.
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.
What if my patient doesn't have internet access, or access to a platform with video capabilities?
You can bill real-time, interactive audio-only telehealth visits that have been requested by the patient, so you can serve your patients who don’t have internet access or audio-visual capabilities. Effective July 1, 2020, all audio-only visits must be billed using audio-only visit codes (99441 – 99443, 98966 – 98968). No other codes can be billed for audio-only visits.