You know that CMS will not reimburse the new CPT telehealth codes (
PBN 1/23/24, subscription required). However, some commercial plans are picking up the new codes (
98000-98015).
If your practice provides telehealth services in place of office/other outpatient E/M visits you will need to research each plan, write up your findings and communicate them to relevant members of your team.
Remember to note whether the plan covers audio/video services (98000-98007), audio-only services (98008-98015) or both, plus any place of service and modifier requirements. Finally, make sure you’re signed up to receive policy updates from each plan to stay on top of changes.
A quick check of several commerical payers revealed a variety of policies (see the telehealth coverage scorecard below).
The following plans accept telehealth codes 98000-98015:
The following plans do not accept the new codes and instruct providers to stick with the office/outpatient codes for telehealth services:
Help PBN build a complete telehealth coding scorecard for commercial plans. Share your commercial payers' telehealth coverage policies with links in the comments section and we’ll update the scorecard.
Telehealth coding scorecard
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Payer
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98000-98015
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99202-99215
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BCBSNC
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✓
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BCBSND
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✓
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BCBSSC
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98000-98007
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|
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✓
|
|
Premera Blue Cross
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✓
|
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PHP
|
✓
|
|
UnitedHealth Care
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|
✓
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|
|
|
|
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|
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