Commercial

Medical Policy

Title:

Telemedicine Services

Policy #:

00.10.41q

Policy

The 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.

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

TELEMEDICINE

SERVICES ELIGIBLE FOR REIMBURSEMENT
In accordance with the member's benefits, telemedicine as a method of delivery of health care services between a provider and an individual is eligible for reimbursement consideration by the Company when all of following requirements are met:

The service is medically necessary and able to be delivered using one of the following methods:

Interactive, synchronous (real-time), two-way audio and video communications
Interactive, synchronous (real-time), two-way audio communications
Asynchronous (store and forward) delayed communications, with the intent to allow the individual to be evaluated by the provider without being physically present.

The encounter takes place via a secure Health Insurance Portability and Accountability Act (HIPAA)–compliant interactive communications system.
The service provided meets the same standard of care requirements or practice standards as would be provided if the services were performed in-person.

Physical health services performed through telemedicine by an Independence-participating professional provider will be reimbursed at 85% of the provider contracted fee schedule.

Behavioral health services performed through telemedicine by an Independence-participating professional provider will be reimbursed at 100% of the provider contracted fee schedule.

NOT ELIGIBLE FOR REIMBURSEMENT

The following are not eligible for reimbursement:

The primary purpose of the service is to assess the appropriate place of service.

The service is provided through a telecommunications system that does not have HIPAA-compliant encryption.

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.

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 Evaluation and Management (E/M) services, counseling, or physical health services.

Communications and/or transmission of supporting documentation between consulting provider and treating provider.

Communications performed solely through electronic mail, instant messaging, phone text, or facsimile transmission.

Physical health services performed through telemedicine that are not reported with both the appropriate modifier and the appropriate place of service.

CAPITATION SERVICES AND REIMBURSEMENT

For Health Maintenance Organization (HMO) or HMO Point-of-Service (HMO-POS) products with capitation arrangements, most 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 95 or GQ) and place-of-service code 02 or 10 to represent telemedicine services.

Modifier G0 and FR are reported for informational purposes only and must be reported in conjunction with the appropriate telemedicine modifier listed above.

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.

MANDATES

The laws of the state where the group benefit contract is issued determine the mandated coverage.

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 telecommunications system. 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

Alder S. HIPAA Guidelines on Telemedicine. The HIPAA Journal. April 9, 2025. Available at: HIPAA Guidelines on Telemedicine - Updated for 2025. Accessed September 4, 2025.

American Academy of Family Physicians. Primary care. [AAFP Web site]. January 2022. Available at: http://www.aafp.org/about/policies/all/primary-care.html. Accessed September 4, 2025.

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 September 4, 2025.

Federation of State Medical Boards. Telemedicine Policies. [FSMB Web site]. June 2021. Available at: telemedicine_policies_by_state.pdf (fsmb.org). Accessed September 4, 2025.

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)

NOT ELIGIBLE FOR REIMBURSEMENT

99446, 99447, 99448 , 99449, 99451, 99452

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

N/A

HCPCS Level II Code Number(s)

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

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

G2025 Distant site telehealth services performed by RHC and FHQC

Q3014 Telehealth originating site facility fee

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub
Modifiers

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

G0 Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke

GQ Via Asynchronous telecommunications system

GT Via interactive audio and video telecommunications system

Coding and Billing Requirements

Cross Reference

Policy History

Revisions From 00.10.41q:

01/01/2026

This version of the policy will become effective 01/01/2026.

The policy criteria were updated to:

To clarify telemedicine and telehealth services is covered for medically necessary services provided at the same standard of care as if the service was provided in person for all specialties.
Allow two-way audio communication to be covered when reported without store and forward communications for all specialties.
To allow asynchronous communications for all specialties

The billing requirements was updated to allow GQ as an eligible modifier.

The eligible procedure codes and revenue codes were removed from the policy and will remain eligible.

The following codes were removed from the policy, and the coverage position was changed from not eligible for reimbursement to eligible: 98966, 98967, 98968, 98970, 98971, 98972, G2061, G2062, G2063, G0071, G2010, G2250, G2251, G2252.

The following codes were removed from the policy. The coverage position should remain the same: G0508, G0509

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:

01/01/2025

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 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 00.10.41m:

11/13/2024	This policy has been reissued in accordance with the Company's annual review process.
07/01/2024	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 07/01/2024. 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:

06/01/2022

This 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.
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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:

01/01/2022

This 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:

07/01/2021

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:

04/01/2020

This 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:

01/01/2020

This 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:

01/02/2019

The 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:

01/01/2019

The 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:

11/07/2018	This policy has been reissued in accordance with the Company's annual review process.
01/12/2018	The 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.

Version Effective Date:

1/1/2026

Version Issued Date:

1/2/2026

Version Reissued Date:

Commercial

Medical Policy

Notification

Policy

Guidelines

Description

References

Coding

CPT Procedure Code Number(s)

ICD - 10 Procedure Code Number(s)

ICD - 10 Diagnosis Code Number(s)

HCPCS Level II Code Number(s)

Revenue Code Number(s)

MPMiscCodesNarrativesPubModifiers

Coding and Billing Requirements

Cross Reference

Policy History

MPMiscCodesNarrativesPub
Modifiers