Editor's Note: This is an addendum to Sam's "Billing for Telemedicine Services, also in this issue. We have included it here, rather than in a future issue, so DCs and their patients can take advantage of these expanded coverage options immediately.
Question: I am attempting to best understand the correct coding and billing for telemedicine services (thank you for your latest article). I recently heard chiropractors can also provide and bill for some therapies; is this true?
Under typical circumstances, telemedicine services are generally coded with three code sets: evaluation and management codes 99201 to 99215, online digital evaluation and management codes 99421 to 99423, and telephone evaluation and management service codes 99441 to 99443.
UHC Coverage Description
UnitedHealthcare has made changes to its telehealth reimbursement for chiropractic providers that includes the codes listed above, but also some physical medicine services. UHC announced this change for services beginning on or after March 18, 2020 and ending on June 18, 2020.
This update by UHC appears to go in concert with updates that CMS / Medicare has made referencing additional services that would be allowed through telemedicine visits, including some therapies. Of course, Medicare only covers chiropractic for spinal manipulation, so this update by CMS does not affect chiropractic billing or reimbursement.
The therapy codes allowed by UnitedHealthcare for a video visit are:
- 97110: Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility. The health care provider and/or patient performs therapeutic exercises to one or more body areas to develop strength, endurance and flexibility.
- 97112: Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture and proprioception. Examples include proprioceptive neuromuscular facilitation (PNF), Feldenkrais, Bobath, BAPS boards, and desensitization techniques. Each 15 minutes.
- 97116: Gait training (includes stair climbing), each 15 minutes.
- 97530: Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes. Dynamic therapeutic activities designed to achieve improved functional performance (e.g., lifting, pulling, bending) are used.
- 97535: Self-care / home management training including ADL training, compensatory training, discussing safety procedures / instructions, meal preparation, and use of assistive technology devices or adaptive equipment. Each 15 minutes.
UHC will reimburse claims including one of the CPT codes from the list, as long as the claim is submitted on a CMS 1500 form. You must include the place of service that would have been reported had the services been furnished in person, along with a 95 modifier. This means for these claims, the place of service would be 11 for your office and 95 to indicate a telemedicine service.
UHC will reimburse telehealth services submitted by chiropractors for Medicaid, and individual and fully insured group market health plan members. Medicare Advantage coverage limitations still apply, as well as state laws and regulations. Benefits will be processed following the member's plan.
Cost-sharing will be waived for in-network telehealth visits for chiropractic services from March 31, 2020, until June 18, 2020, for Medicaid, individual and fully insured group market health plan members, with opt-in available for self-funded employers.
Remember, this reimbursement change is effective for dates of service from March 18, 2020 until June 18, 2020. Whether or not this time frame will be extended due to continuing physical-distancing requirements has not yet been addressed by United Healthcare. Check the UHC website for updates. (Click here for general COVID-19-related coverage information and here for chiropractic-specific information.)
UnitedHealthcare will not reimburse providers for audio-only visits. All visits must be performed using live video conferencing that involves the presence of both parties at the same time, and a communication link between them that allows real-time audio and visual interaction to take place. Emailing "stored" exercise videos and discussing or reviewing by phone is not reimbursable. Providers must always comply with the requirements of the state that issues their license in providing services.
Aetna Coverage Description
CVS Health / Aetna will cover telehealth-based delivery of the services and procedures by PTs* for CPT codes 97110, 97112, 97116, 97161 to 97164, 97535, 97755, and 97760-97761. Telehealthcare must be provided as a two-way synchronous (real-time) audiovisual service. Providers are required to append the GT modifier to the codes – not the 95 modifier as UnitedHealthcare requires.
*Aetna's coverage expansion does not specifically indicate chiropractors, as does United Health Care; however, based on federal rules of equality, DCs should be eligible for the same coverage benefits.
Cigna Coverage Description
Cigna is indicating it will cover 97110 when provided by telemedicine, but none of the other codes indicated by UHC and Aetna. Cigna also requires the use of modifier GQ to indicate telemedicine. (Yes, different modifiers for each carrier.)
For telemedicine platforms, all three insurers are following CMS standards for technology. The U.S. Department of Health and Human Services, Office for Civil Rights (OCR) is exercising enforcement discretion and waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communication technologies.
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