Group commercial HMO, EPO, POS and PPO plans
Individual commercial MyPriority® plans
- Telemedicine - 91604
Refer to the medical policy for medical necessity criteria, services not covered as virtual services, and coding information.
Use of virtual visits for behavioral health services
Please note: 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. You should bill for these visits using the place of service you normally would, based on your office location.
From the medical policy, page 5:
Telemedicine visits for acute life-threatening medical conditions or psychotherapy may be restricted to hosted sites where the patient can be monitored or assisted by an onsite provider. Behavioral health services in settings other than hosted sites should be limited to stable patients with straightforward needs. Patients with acute psychiatric needs or patients requiring ongoing psychotherapy beyond crisis stabilization may not be candidates for telemedicine.
Virtual service billing
Refer to the medical policy for most coding information. These links will take you to service-specific pages.
Behavioral health services
- ADHD services
- Autism services
- Coordination of care
- Depression diagnosis and management
- Discharge process
- Electroconvulsive therapy
- Medicaid behavioral health
- Mental health services
- Neuropsych/psychological exams, testing
- Psychological E&M of non-mental-health disorders
- Substance use disorder services
- Transcranial magnetic stimulation