COVID-19 update for providers

In response to COVID-19, we implemented several temporary changes to support you and your patients. Below is a summary of these changes, including deadline extensions.  

Continue to reference our COVID-19 Provider Information Center page for the latest news and most up-to-date information.

We've extended coverage of COVID-19 testing and treatment through Dec. 31, 2020 

We'll continue to cover COVID-19 treatment for all our members, with no out-of-pocket health plan costs. That means we'll waive copays, coinsurance and deductibles for COVID-19 treatment from an in-network provider, for dates of service between March 11 and Dec. 31, 2020. We'll also continue to cover medically necessary COVID-19 tests of any kind when ordered by a physician or advanced practice provider (APP), waiving all copays, coinsurance and deductibles.

Learn more about billing and coding for COVID-19 treatment and testing.

We've expanded coverage of virtual care and telehealth services for our members through Dec. 31, 2020

We recognize that in-office visits might not be an option for your practice, or your patients. To encourage our members to continue seeking the care and services they need to stay healthy, we're covering the cost of all virtual care and telehealth visits, including behavioral health, at 100% (no copays, coinsurance or deductibles), for most* members for dates of service July 1 - Dec. 31, 2020.  

You don't need to collect member cost-sharing (copays, coinsurance or deductibles) for virtual care and telehealth services, so you can save administrative time and expenses and focus on what matters most.

Learn more and share coverage information with your Priority Health patients.

*Self-funded employer group plans must opt-in

Other telehealth updates and extensions

Temporary expansion of telehealth codes through Dec. 31, 2020

We'll continue to allow credentialed providers to bill routine practice codes, in addition to existing virtual care codes, for services provided via telehealth between March 26 and Dec. 31, 2020. Any credentialed provider or facility can conduct a telehealth visit for a member with any type of plan, including commercial group and individual, Medicare and Medicaid. 

Bill for these visits using modifier 95, or the GT modifier for Medicaid, to identify the visit as telehealth. 

Provider reimbursement for expanded telehealth services

For dates of service between May 1 and Dec. 31, 2020, we’ll continue to pay the same rate for expanded telehealth services as you’re accustomed to receiving for in-person visits.  

Audio-only visits for telehealth

We'll continue to allow credentialed providers to bill real-time, interactive, audio-only telehealth encounters, so patients who don't have internet access or audio-visual capabilities can continue to get the care they need. Effective July 1, 2020, all audio-only visits must be billed using audio-only visit codes (99441 - 99443 and 98966 - 98968).

HIPAA compliance

We'll continue the suspension of the requirement for HIPAA-compliant systems for virtual visits and telehealth appointments through the end of the public health emergency.

Learn more about virtual visits and telehealth on our COVID-19 Provider Information Center.