Commercial

Coverage of Speech Therapy Services Performed Through Telemedicine for Independence Commercial Members


Policy Impacted


00.10.41

Purpose

The purpose of this communication is to provide notice regarding coverage for speech therapy services performed through telemedicine for our Independence Commercial members during the coronavirus disease 2019 public health emergency.

 

This communication addressing coverage of speech therapy performed through telemedicine is effective from March 6, 2020 through January 1, 2022 and will be reviewed for continued coverage during the public health emergency.​


Background

There is currently an outbreak of respiratory disease caused by a novel coronavirus, which has been detected both nationally and internationally. The virus has been named “SARS-CoV-2" and the disease it causes has been named “Coronavirus Disease 2019" (COVID-19). 

 

To help reduce potential exposure, members and participating providers may perform speech therapy through telemedicine as detailed below and available as part of a member's plan.​


Coverage Statement

Coverage is subject to the terms, conditions, and limitations of the member's contractThe Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member's medical needs and condition.

Note: This communication does not address services provided through the Company's contracted telemedicine vendor.


COVERED


Speech therapy performed through telemedicine via a secure Health Insurance Portability and Acc​ountability Act (HIPAA)--compliant telecommunications system using interactive, synchronous (real-time) two-way audio and video communications is covered and is eligible for reimbursement consideration by the company when reported by one of the procedure codes in the coding section below.

 

NOT ELIGIBLE FOR REIMBURSEMENT


Speech therapy performed through telemedicine ​is not eligible for reimbursement consideration for the following:

  • Transmission of digitalized data between the provider and individual reported with modifier GQ is not reimbursed separately from the subsequent synchronous service.
  • Administrative matters, including but not limited to, scheduling, registration, updating billing information, reminders, requests for medication refills or referrals, ordering of diagnostic studies, and medical history intake completed by the patient.
  • Any CPT or HCPCS code that is not listed in the code section of this communication if billed with modifier 95 or GT or place of service 02.
  • Any equipment used for telemedicine communications.
  • Communications including, but not limited to reporting of test results and provision of educational materials are incidental to medical services included in this communication. 


REQUIRED DOCUMENTATION 

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the professional provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.


BILLING REQUIREMENTS

Professional providers performing speech therapy through telemedicine must report the appropriate modifier (modifier GT or 95) and place-of-service code 02 (Telehealth) to represent telemedicine services.


Speech therapy performed through telemedicine reported by facilities billing on a UB-04 claim form, or the equivalent form 837i, should report the appropriate revenue code (shown below) along with the corresponding procedure code representing the service provided appended by the GT or 95 modifier, as needed.


Speech therapy performed through telemedicine is only reimbursed when reported with eligible procedure codes, appropriate modifiers, and the place of service code identified in this communication. Any applicable member cost-share will be applied.

Inclusion of a code in this communication does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.​​​​


Coding

CPT CODES

92507
92508
92521
92522
92523
92524
92607
92608
92609
97129
97130

HCPCS CODES

​S9152 Speech therapy, re-evaluation


REVENUE CODES

0441 Speech Therapy (ST) – Visit Charge
0442 Speech Therapy (ST) – Hourly
0444 Speech Therapy (ST) – Evaluation or Reevaluation


9/23/2021