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Telemedicine Services
00.10.41p

Policy

The Com​pany 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.


This policy does not describe telemedicine services that are provided by a telemedicine vendor.


TELEMEDICINE FOR PHYSICAL HEALTH SERVICES

 
SERVICES COVERED AND ELIGIBLE FOR REIMBURSEMENT
Telemedicine as a method of delivery of physical health services between a provider and an individual that is reported via one of the procedure codes in the coding section below is covered and eligible for reimbursement consideration by the Company when all of following requirements are met:

  • Eligible Services
    • The physical health services performed are any of the following:
      • Evaluation and management services (e.g., office visits)
      • End-stage renal disease services
      • Medical genetics and genetic counseling
      • Medical nutrition therapy
      • Transitional care management
      • Lactation counseling 
      • Hospice care
  • Specialty Eligibility
    • The physical health services are medically necessary when performed by a primary care provider (PCP) or an eligible medical specialty provider who is licensed in the state in which the individual originates the telemedicine encounter. 
    • Note: The following specialties are NOT eligible for reimbursement of telemedicine services:
      • Manipulative Therapy
      • Neuromuscular Manipulative Medicine
      • Respiratory Therapy
      • Anesthesiology
      • Radiology
      • Pathology
      • Emergency Medicine
      • Medical Microbiology
      • Medical Toxicology
      • Nuclear Medicine
      • Immunology (Note: This is different from allergy and immunology medical specialty)  
      • Medical and Clinical Biochemical Genetics
      • Clinical Cytogenetics
      • Critical Care Services
  •   Modes of Communication
    • Telemedicine services may be covered when the encounter takes place via a secure Health Insurance Portability and Accountability Act (HIPAA)–compliant telecommunications system using one of the following modes of communication:  
      • Interactive, synchronous (real-time) two-way audio and video communications for all eligible specialties
      • Asynchronous telecommunication (store and forward transmission) in conjunction with synchronous audio interaction (e.g., telephone call reported with 98008-98015)​ for the following specialties ONLY:
        • Optometry
        • Ophthalmology
        • Dermatology
      • Telephone (e.g., audio telecommunication only/telephone call reported with 98008-98015​) communication ​for the following specialties ONLY:
        • Clinical Genetics
        • Medical Genetics​​​​​​​​
When the physical health services listed above are performed through telemedicine by an Independence-participating professional provider, reimbursement for the medical service will be at 85% of the provider allowance, subject to the specific terms and conditions of the participation agreement.​​​

TELEMEDICINE FOR BEHAVIORAL HEALTH SERVICES
​
​​Telemedicine coverage for behavioral health services are eligible for reimbursement consideration by the Company when all the following criteria are met: 
  • ​​The services are medically necessary and able to be delivered via a secure Health Insurance Portability and Accountability Act (HIPAA)–​compliant telecommunications system ​using one of the following modes of communication: 
    • Interactive, synchronous (real­-time) two­-way audio and video communications 
    • A telephone (i.e., audio telecommunication only/telephone call) or online digital communication
  • The telemedicine services are reported with one of the procedure codes listed in the coding section below.
​​NOT ELIGIBLE FOR REIMBURSEMENT

Telemedicine services are not eligible for reimbursement consideration for the following: ​
  • Triage to assess the appropriate place of service
  • 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 eligible code section of this policy if billed with modifier 93, 95, GT, or FQ or place of service 02 or 10
  • The originating site of service fee or facility fee
  • Any equipment used for telemedicine communications
  • Communications including, but not limited to, reporting of test results and provision of educational materials are incidental to E/M services, counseling, or physical health services included in this policy​
CAPITATION SERVICES AND REIMBURSEMENT

  • For Health Maintenance Organization (HMO) or HMO Point-of-Service (HMO-POS) products with capitation arrangements, services delivered through telemedicine are considered included in capitation, with the exception of those services identified in applicable policies identifying fee-for-service reimbursement. Refer to the appropriate claim payment policies for a list of exceptions to capitation arrangements.
  • For members enrolled in HMO or HMO-POS products with PCP capitation, any capitated services (e.g., laboratory testing, radiology studies, physical therapy, occupational therapy) must be referred to the PCP's designated capitated sites.
  • Members enrolled in HMO or HMO-POS products seeking primary care services through telemedicine from a PCP must obtain services from their selected PCP.
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 telemedicine services described in this policy must report the appropriate modifier (modifier FQ, GT, 93 or 95) and place-of-service code 02 or 10 to represent telemedicine services.

The services described in this policy are only reimbursed as telemedicine services when reported with eligible procedure codes, appropriate modifiers, and the place of service code identified in this policy. Any applicable member cost-share will be applied.

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

Guidelines

Other telemedicine coverage options may be available, such as those administered by a third-party vendor. The options may differ from the medical services and behavioral health services for telemedicine addressed in this policy.


BENEFIT APPLICATION
 
Subject to the terms and conditions of the applicable benefit contract, telemedicine as described in this policy is covered under the medical benefits of the Company's products.​

Description

Telemedicine is the delivery of healthcare services to a member at an originating site by a professional provider at a distant site via a secure audiovisual telecommunications system. Telemedicine includes the delivery of remote healthcare via a growing variety of secure applications of telecommunication systems including video, smart phones, and wireless tools that allow for both audio and video transmission, permitting two-way contact that is interactive and real-time between an individual and a professional provider. Telemedicine does not address communications between professional providers and individuals via short message service, or social network sites. 


Telemedicine was originally created as a way to treat individuals who were located in remote places, long distances from local health facilities or in areas of with shortages of medical professional providers. While telemedicine is still used today to address these challenges, rapid changes in technology have transformed telemedicine into a tool for an accessible, convenient healthcare delivery system for ​healthcare services. 


Telemedicine is used to support healthcare when the professional provider and the individual are physically separated. A telemedicine service includes both a distant site and an originating site. A distant site is the location at which the professional provider delivering the service is located during the time the service is provided. An originating site is the location of the individual seeking healthcare services at the time the service is initiated.​

References

American Academy of Family Physicians. Primary care. [AAFP Web site]. 2021. Available at: http://www.aafp.org/about/policies/all/primary-care.html. Accessed August 11, 2021.


American Telemedicine Association (ATA). Practice guidelines for telemental health with children and adolescents. March 2017. Available at: https://www.cdphp.com/-/media/files/providers/behavioral-health/hedis-toolkit-and-bh-guidelines/practice-guidelines-telemental-health.pdf?la=en. Accessed August 11, 2021.


Federation of State Medical Boards. Telemedicine Policies. [FSMB Web site]. June 2021. Available at: telemedicine_policies_by_state.pdf (fsmb.org)​. Accessed August 11, 2021.


Hewitt H, Gafaranga J, McKinstry B. Comparison of face-to-face and telephone consultations in primary care: qualitative analysis.  Br J Gen Pract. 2010; 60(574):201-212.

Coding

CPT Procedure Code Number(s)

PHYSICAL HEALTH SERVICES ELIGIBLE FOR COVERAGE VIA TELEMEDICINE


90951, 90952, 90954, 90955, 90957, 90958, 90960, 90961, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 92227, 92228, 96040, 96110, 96127, 97802, 97803, 97804, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99406, 99407, 99408, 99409, 99421, 99422, 99423, 99483, 99495, 99496, 99497, 99498


THE FOLLOWING CODES ARE USED TO REPRESENT SERVICES FOR LACTATION COUNSELING:


99401, 99402, 99403, 99404, 99411, 99412


SYNCHRONOUS AUDIO INTERACTION (TELEPHONE) WITH ASYNCHRONOUS TELECOMMUNICATION IS ELIGIBLE FOR COVERAGE BY OPTOMETRY, OPHTHALMOLOGY, AND DERMATOLOGY SPECIALTIES


99441, 99442, 99443


SYNCHRONOUS AUDIO INTERACTION (TELEPHONE ONLY) IS ELIGIBLE FOR COVERAGE BY CLINICAL GENETICS AND MEDICAL GENETICS SPECIALTIES


99441, 99442, 99443


THE FOLLOWING CODES ARE USED TO REPRESENT SERVICES FOR SPEECH THERAPY:


92507, 92508, 92521, 92522, 92523, 92524, 92607, 92608, 92609, 97129, 97130


THE FOLLOWING CODES ARE USED TO REPRESENT SERVICES FOR APPLIED BEHAVIORAL ANALYSIS (ABA):


0362T, 0373T, 97151, 97153, 97154, 97155, 97156, 97157, 97158


BEHAVIORAL HEALTH SERVICES ELIGIBLE FOR COVERAGE VIA TELEMEDICINE


90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90846, 90847, 90849, 90853, 90875, 96110, 96112, 96113, 96116, 96121, 96125, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350


PHYSICAL HEALTH AND BEHAVIORAL HEALTH SERVICES NOT ELIGIBLE FOR COVERAGE VIA TELEMEDICINE


THE FOLLOWING CODES ARE USED TO REPRESENT SERVICES NOT CONSIDERED TELEMEDICINE AND ARE NOT ELIGIBLE FOR REIMBURSEMENT:


98970, 98971, 98972, 99446, 99447, 99448 , 99449, 99451, 99452


THE FOLLOWING CODES ARE USED TO REPRESENT SERVICES NOT CONSIDERED TELEMEDICINE AND ARE CONSIDERED BENEFIT EXCLUSIONS:


98966, 98967, 98968

ICD - 10 Procedure Code Number(s)
N/A
ICD - 10 Diagnosis Code Number(s)
N/A
HCPCS Level II Code Number(s)

PHYSICAL HEALTH SERVICES ELIGIBLE FOR COVERAGE VIA TELEMEDICINE
 
G0108 Diabetes outpatient self-management training services, individual, per 30 minutes


G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes


G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face-to-face with the patient, each 15 minutes


G0296 Counseling visit to discuss need for lung cancer screening using low dose CT scan (LDCT) (service is for eligibility determination and shared decision making)


G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and brief intervention 15 to 30 minutes


G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and intervention, greater than 30 minutes


G0442 Annual alcohol misuse screening, 5 to 15 minutes


G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes


G0444 Annual depression screening, 5 to 15 minutes


G0445 Semiannual high intensity behavioral counseling to prevent STIs, individual, face-to-face, includes education skills training and guidance on how to change sexual behavior


G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes


G0447 Face-to-face behavioral counseling for obesity, 15 minutes


G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)


S0265 Genetic counseling, under physician supervision, each 15 minutes

THE FOLLOWING CODES ARE USED TO REPRESENT SERVICES FOR LACTATION COUNSELING:

S9443 Lactation classes, nonphysician provider, per session

THE FOLLOWING CODE IS USED TO REPRESENT SERVICES FOR SPEECH THERAPY:
S9152 Speech therapy, re-evaluation


THE FOLLOWING CODES ARE USED TO REPRESENT SERVICES NOT CONSIDERED TELEMEDICINE AND ARE CONSIDERED BENEFIT EXCLUSIONS:
 
S0320 Telephone calls by a registered nurse to a disease management program member for monitoring purposes; per month 
S5185 Medication reminder services, non-face-to-face; per month


BEHAVIORAL HEALTH SERVICES ELIGIBLE FOR COVERAGE VIA TELEMEDICINE
 

G0017 Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes

G0018 Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service)


G0316 Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (Do not report G0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (Do not report G0316 for any time unit less than 15 minutes)


G0317 Prolonged nursing facility evaluation and management service(s) beyond the  total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99306, 99310 for nursing facility evaluation and management services). (Do not report G0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (Do not report G0317 for any time unit less than 15 minutes)


G0318 Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99345, 99350 for home or residence evaluation and management services). (Do not report G0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (Do not report G0318 for any time unit less than 15 minutes)G0406 Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth


G0407 Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth


G0408 Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth


G0425 Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth


G0426 Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth


G0427 Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth

G0459 Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy

H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education


H0035 Mental health partial hospitalization, treatment, less than 24 hours


H2020 Therapeutic behavioral services, per diem​


S0201 Partial hospitalization services, less than 24 hours, per diem


S9480 Intensive outpatient psychiatric services, per diem

PHYSCIAL HEALTH AND BEHAVIORAL HEALTH SERVICES NOT ELIGIBLE FOR COVERAGE VIA TELEMEDICINE


THE FOLLOWING CODES ARE USED TO REPRESENT SERVICES NOT CONSIDERED TELEMEDICINE AND ARE NOT ELIGIBLE FOR REIMBURSEMENT:
 

G0546 Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty   whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 5-10 minutes of medical consultative discussion and review

G0547 Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 11-20 minutes of medical consultative discussion and review

G0548 Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 21-30 minutes of medical consultative discussion and review

G0549 Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 31 or more minutes of medical consultative discussion and review

G0550 Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a written report to the patient's treating/requesting practitioner, 5 minutes or more of medical consultative time

G0551 Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, 30 minutes​


G2061 Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes


G2062 Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes


G2063 Qualified nonphysician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes


THE FOLLOWING CODES ARE NOT ELIGIBLE FOR REIMBURSEMENT:
 
G0071 Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only


G0508 Telehealth consultation, critical care, initial, physicians typically spend 60 minutes communicating with the patient and providers via telehealth


G0509 Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth

G2010 Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment


G2025 Distant site telehealth services performed by RHC and FHQC


G2250 Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment

G2251 Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
​
G2252 Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and managemg0442ent services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion

Q3014 Telehealth originating site facility fee​​​​

Revenue Code Number(s)

MEDICAL SERVICES ELIGIBLE FOR COVERAGE VIA TELEMEDICINE
 
0441 Speech Therapy (ST) – Visit Charge

0442 Speech Therapy (ST) – Hourly

0444 Speech Therapy (ST) – Evaluation or Reevaluation

0651 Hospice Service - Routine Home Care
 
0652 Hospice Service - Continuous Home Care

BEHAVIORAL HEALTH SERVICES ELIGIBLE FOR COVERAGE VIA TELEMEDICINE

0905 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Intensive Outpatient Services-Psychiatric

0906 Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Intensive Outpatient Services-Chemical Dependency

0912 Behavioral Health Treatments/Services-Extension of 090X-Partial Hospitalization-Less Intensive

0913 Behavioral Health Treatments/Services-Extension of 090X-Partial Hospitalization-Intensive

Modifiers

COVERED

93 Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System​

95 Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System
FQ The service was furnished using audio-only communication technology

FR The supervising practitioner was present through two-way, audio/video communication technology​

GT Via interactive audio and video telecommunications system

NOT COVERED​

GQ Via Asynchronous telecommunications system

Coding and Billing Requirements

Policy History

Revisions From 00.10.41p:

07/01/2025​Inclusion of a policy in a Code Update memo does not imply that a full review of the policy was completed at this time.
​​
This policy has been identified for the HCPCS code update, effective 07/01/2025.

The following HCPCS code has been terminated (no longer valid codes) from this policy: G9037


Revisions From 00.10.41o:​

04/07/2025

The following HCPCS code has been added to this policy in the behavioral health section:


H2020

​​
Revisions From 00.10.41n:
01/01/2025Inclusion of a policy in a Code Update memo does not imply that a full review of
the policy was completed at this time.

This policy has been identified for the CPT modifier code update, effective 01/01/2025.

The following CPT code has been added to this policy as not eligible for reimbursement:​

98016 


The following HCPCS codes have been added to this policy as not eligible for reimbursement:​ G0546, ​G0547, G0548, G0549, G0550, G0551 

The following CPT codes have been added to this policy as eligible: 96041, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007 

The following CPT codes have been added to this policy as eligible for physical health services when reported by Optometry, Ophthalmology, Dermatology, Medical and Clinical Genetics, and Behavioral Health specialties : 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015 

The following CPT  codes have been termed (no longer valid code) from this policy: 96040, 99441, 99442, 99443, G2012 

The following CPT  narratives have been revised in this policy: 98970, 98971, 98972

Revisions From 00.10.41n:
​11/13/2024

​This policy has been reissued in accordance with the Company's annual review process.​
07/01/2024Inclusion of a policy in a Code Update memo does not imply that a full review of
the policy was completed at this time.

This policy has been identified for the  HCPCS code update, effective 07/01/2024.

The following HCPCS  code has been added to this policy:

NOT ELIGIBLE FOR REIMBURSEMENT
G9037 ​


Revisions From 00.10.41l:

01/02/2023

Inclusion of a policy in a Code Update memo does not imply that a full review of the policy was completed at this time.

This policy has been identified for the CPT and HCPCS code update, effective 01/02/2024.

The following HCPCS codes have been added to this policy: G0017, G0018  
 
The following CPT narratives have been revised in this policy: 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99306, 99308​


Revisions From 00.10.41k:

01/01/2023
This version of the policy will become effective 01/01/2023.​

The following CPT codes have been added to this policy: 0362T, 0373T, 92507, 92508, 92521, 92522, 92523, 92524, 92607, 92608, 92609, 96110, 96112, 96113, 97129, 97130, 97151, 97155, 97156, 97157
​
The following HCPCS code has been added to this policy: S9152
​
The following revenue codes have been added to this policy: 0441, 0442, 0444
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On 12/15/2022, the following 1/1/2023 CPT code updates were made to this policy while in Notification:​

The following HCPCS codes have been added to this policy:

G0316, G0317, G0318

The following CPT and HCPCS code has been termed in this policy:

99217, 99218, 99219, 99220, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99343, 99354, 99355, 99356, 99357

The following CPT code narratives have been revised:

99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99483, 99495, 99496, G0442, G0444​

Revisions From 00.10.41j:

06/01/2022This version of the policy will become effective 06/01/2022.
The policy is being updated to address a change in provider reimbursement for certain services delivered through telemedicine.
-----------------------------------------------------------------------------------------------------
Note: On 05/02/2022, as a clarification to the the policy language and coding section for the telephone services as a mode of communication, procedure codes 99441-99443 were added as an example of how service performed through telephone communications can be reported.

​ 

Revisions From 00.10.41i:

01/01/2022This policy has been identified for the CPT code, modifier, and place of service update, effective 01/01/2022.

The following modifiers have been added to this policy: FQ, FR

The following place of service codes has been added to this policy: 10

The following CPT code narrative has been revised: 99211​


Revisions From 00.10.41h:
07/01/2​021

This version of the policy will become effective 07/01/2021. The policy criteria were updated to address eligible services and provider specialties. 

 

The following codes were removed from the policy and are not eligible for coverage through telemedicine:

77427, 90849, 90853, 90875, 90953, 90956, 90959, 90962, 92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92601, 92602, 92603, 92604, 92607, 92608, 92609, 94002, 94003, 94004, 94664, 96112, 96113, 96116, 96121, 96125, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96164, 96165,  97110, 97112, 97116, 97150, 97153, 97154, 97158, 97161, 97162, 97164, 97168, 99201​, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99224, 99225, 99226, 99234, 99235, 99236, 99238, 99239, 99291, 99292, 99315,  99316, 99324, 99325, 99326, 99327, 99328, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349,  99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396,  99397, 99468, 99469, 99471, 99472, 99473, 99475, 99476, 99477, 99478, 99479, 99480, 0362T, 0373T,  G0420, G0421, G0438, G0439, G9685, 93797, 93798, S9472, G0424, S9473, H0015, S9480, H0035,  S0201, 97129, 97130, 97163, 97166, 97167, 97530, 97533, 97535, 97542, 97750, 97755, 97760, 97761,  97129, 97130, G0153, G0161, S9128, S9152, S9083
 

The following revenue codes were removed from the policy and are not eligible for coverage through telemedicine:

0561, 0562, 0551, 0420, 0421, 0422, 0424, 0431, 0432, 0434, 0441, 0442, 0444, 0590, 0905, 0906, 0912, 0913, 0655, 0656, 0943, 0948, 0780

 

The following codes were added to the policy as eligible through telemedicine: 
92227, 96040, 99408, 99409, S0265​

​ 

The position of the following codes were changed from eligible to not eligible for reimbursement:

G0071, G0508, G0509, G2010, G2012, G2061, G2062, G2063

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Note: The policy in notification was updated 04​/01/2021 to include the following changes:
The modes of communication policy criteria in the medical services section was updated to address asynchronous telecommunications in conjunction with a synchronous audio communication would be considered eligible for reimbursement. ​Additional not eligible for reimbursment criteria was added to the policy. ​ 

The following codes were removed from the policy and are not eligible for coverage through telemedicine:​ 92507, 92508

The position of the following code was changed from eligible to not eligible for reimbursement: G2025

Modifier GQ position was changed from covered to not covered. ​


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​Note: The policy in notification was updated July 1, 2021 to include the following changes. 

The following behavioral health codes were added to be eligible for coverage through telemedicine:
 90849, 90853, 90875, 96116, 96121, 96125, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96164, 96165, 97153, 97154, 97158, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99234, 99235, 99236, 99238, 99239, 99324, 99325, 99326, 99327, 99328, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349,  99350, H0015,  H0035, S0201, S9480,

The following rev codes were added to be eligible for coverage through telemedicine: ​

0905, 0906, 0912, 0913, ​

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​Note: The policy in notification was updated July 7, 2021 to include the following changes.


Policy criteria was clarified for the telemedicine coverage for behavioral health services to allow real-time audio and video and telephone modes of communication. ​

​

Revisions From 00.10.41g:

04/01/2020This policy has been identified for the HCPCS code update, effective 04/01/2020.

The following HCPCS narratives have been revised in this policy: G2061 G2062 G2063

Revisions From 00.10.41f:
01/01/2020This policy has been identified for the CPT and HCPCS code update, effective 01/01/2020.

The following ICD-10 CM codes have been added to this policy: 98970 98971 98972 99421 99422 99423 G2061 G2062 G2063

The following CPT codes have been termed from this policy: 98969 99444

Revisions From 00.10.41e:
01/02/2019The policy criteria section was updated to allow behavioral health providers to perform telemedicine.

The following codes were added under the behavioral health section: 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90846, 90847, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99231, 99232, 99233, 99307, 99308, 99309, 99310, 99354, 99355, 99356, 99357, G0406, G0407, G0408, G0425, G0426, G0427, G0459, Q3014.

Revisions From 00.10.41d:
01/01/2019The following CPT codes have been termed from this policy: 0188T, 0189T.

The following CPT codes have been added to this policy as not eligible for reimbursement: 99451, 99452.

The following HCPCS codes have been added to this policy as not eligible for reimbursement: G0071, G2010, G2012.

Revisions From 00.10.41c:
11/07/2018This policy has been reissued in accordance with the Company's annual review process.
01/12/2018The policy was updated to remove the billing requirement for modifiers.

Effective 10/05/2017 this policy has been updated to the new policy template format.
7/1/2025
7/1/2025
00.10.41
Claim Payment Policy Bulletin
Commercial
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Independence Blue Cross is a subsidiary of Independence Health Group, Inc. — independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.