Telehealth CPT codes and COVID-19 CPT codes

CPT Codes for COVID-19 testing

U0001: Used specifically by the CDC for testing patients for COVID-19
U0002: Allows laboratories to bill for non-CDC lab tests for COVID-19
87635:  SARS-CoV-2 (COVID-19); amplified probe technique (naso-pharyngeal swab)

ICD Codes for COVID-19 testing

U07.1 – COVID-19, virus identified is assigned to a disease diagnosis of COVID-19 confirmed by laboratory testing.
U07.2 – COVID-19, virus not identified is assigned to a clinical or epidemiological diagnosis of COVID-19 where laboratory confirmation is inconclusive or not available.

Telehealth - Covid

Telehealth billing guidance for major insurances

Category

Required Connection

Effective Date

Coverage Period

Member Cost-Share

Billing Guidance

Products Covered

Code Coverage
Telehealth (Audio+Video) Audio+Video March 17, 2020 90 days Waived for all services during the effective period Place of Service “02”; append modifier “GT” to applicable CPT/HCPCS code(s) All plans and products E/M codes 99201-99215

Telephonic

 

 Audio only March 17, 2020 90 days Waived for all services during the effective period Place of Service “02”; append appropriate modifier All plans and products, except for MEDICAID 99441-99443

 

Please check the below link for more detail

https://providers.amerigroup.com/pages/ga-2012.aspx

 

Category

Required Connection

Effective Date

Coverage Period

Member Cost-Share

Billing Guidance

Products Covered

Code Coverage
Telehealth Audio & Visual 17-Mar-20 December 31, 2020 Waived for COVID-19 treatment; Anthem will leave patient cost-sharing for services not related to COVID-19 Submit with the CPT code rendered; Place of Service 11; and append either modifier “95”. Fully Insured Employer Plans; Individual Plans; Medicare Plans. Self-Insured Groups may opt out of this coverage 99201-99215; 99381-99397; G0438; G0439
Telephonic Only Audio 19-Mar-20 December 31, 2020 Waived for COVID-19 treatment; Anthem will leave patient cost-sharing for services not related to COVID-19   Fully Insured Employer Plans; Individual Plans; Medicare Plans. Self-Insured Groups may opt out of this coverage 99441-99443; G2010; G2012; 98966, 98967, 98968

 

Please check the below link for more detail.

https://providernews.anthem.com/georgia/article/information-from-anthem-for-care-providers-about-covid-19-4

Category

Required Connection

Effective Date

Coverage Period

Member Cost-Share

Billing Guidance

Products Covered

Code Coverage
Telehealth Audio & Visual 4-Mar-20 Aetna’s liberalized telemedicine regulations for Commercial plans will remain until August 4, 2020; waived cost-sharing for Commercial plans ends June 4, 2020–except for Behavioral Health services which will continue to September 30, 2020. For MEDICARE ADVANTAGE, cost-sharing is waived for virtual Primary Care and Behavioral Health services through September 30, 2020. Waived, if related to testing/treatment of COVID-19; Diagnosis code(s) on claim will indicate COVID-19 Applicable modifiers “GT” or “95” Fully Insured Employer Plans; Individual Plans; Medicare Plans. Self-Insured Groups may opt out of this coverage 99201-99215; 99241-99245; G0438; G0439
Telephonic Only Audio 4-Mar-20 Medicare Advantage plans through September 30, 2020. Waived, if related to testing/treatment of COVID-19; Diagnosis code(s) on claim will indicate COVID-19 Applicable modifiers “GT” or “95” Medicare Plans. 99441-99443; G2010; G2012

 

Please check the below link for more detail.

https://www.aetna.com/health-care-professionals/provider-education-manuals/covid-faq/telemedicine.html

Category

Required Connection

Effective Date

Coverage Period

Member Cost-Share

Billing Guidance

Products Covered

Code Coverage
Telehealth Audio & Visual 10-Mar-20 End of Calendar year 2020 Waived, for all telehealth services for In-network providers POS code “11”; modifier 95 Individual & Group Medicare Advantage Members and Commercial Employer-Sponsored Plans Following CMS guidelines
Telephonic Only Audio 10-Mar-20 End of calendar year 2020 Waived, for all telehealth services for In-network providers Following CMS guidelines Medicare Following CMS guidelines

 

Please check the below link for more detail.

https://docushare-web.apps.cf.humana.com/Marketing/docushare-app?file=3923140

Category

Required Connection

Effective Date

Coverage Period

Member Cost-Share

Billing Guidance

Products Covered

Code Coverage
Telehealth Audio & Visual 17-Mar-20 For COVID-19 related testing/treatment, waived through July 24, 2020. For all other In-Network services, hrough September 30, 2020 for MEDICARE ADVANTAGE For COVID-19 related testing/treatment, waived through July 24, 2020. For all other services, waived for all until September 30, 2020 for Medicare Advantage Members POS code “11” and either “95” or “GT” modifier Medicare Advantage 99201-99215; G0438; G0439
Telehealth Audio & Visual 17-Mar-20 July 24, 2020 For COVID-19 related testing/treatment cost share is waived through July 24, 2020. POS code “11” and either “95” or “GT” modifier Commercial Plans (this includes telephonic only services and online patient portal services) 99201-99215; G0438; G0439
Telephonic Only Audio   September 30, 2020   POS code “11” and either “95” or “GT” modifier Medicare Advantage 99201-99215; G0438; G0439; G2010; G2012
Electronic Visit Online Patient Portal   September 30, 2020   For established patients; unrelated to a medical visit within the previous 7 days or resulting in a medical visit within the next 24 hours. Medicare Advantage 99421-99423 & G2061-G2063

Please check the below link for more detail.

https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2020/Telehealth-Patient-Scenarios.pdf?cid=em-other-covid-19email5-apr20

Category

Required Connection

Effective Date

Coverage Period

Member Cost-Share

Billing Guidance

Products Covered

Code Coverage
Telehealth Audio & Visual 2-Mar-20 Through July 31, 2020 Waived for suspected/confirmed COVID-19 cases/Usual cost-shares will apply for all other diagnoses POS code “11”; append either “95” or “GT” modifier Commercial Plans CPT codes 99201-99215
Virtual Screening telephone consult Audio 2-Mar-20 Through July 31, 2020 Waived for all diagnoses   Commercial Plans G2012
Virtual Care for Therapy Services Audio & Visual 2-Mar-20 Through May 31, 2020 Patient cost-share will apply Bill using designated codes for physical; occupational, and speech therapy codes with a “GQ” modifier and standard POS code. Commercial Plans Physical Therapy (97161, 97162 & 97110). Occupational Therapy (97165, 97166, 97110). Speech Therapy (92507, 92526)

 

Please check the below link for more detail.

https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html

Required Connection

Effective Date

Coverage Period

Member Cost-Share

Billing Guidance

Products Covered

Code Coverage
Audio & Visual 03/17/2020 TBD DCH announced starting May 1, 2020 ALL co-payments would be suspended for any service, telehealth or in-office; member cost-share will be waived for COVID-19 related services occuring on or after March 18, 2020. POS code “02” and modifier “GT” Medicaid, PSHP, PeachCare for Kids 99201-99215
Audio only 03/18/2020 TBD DCH announced starting May 1, 2020 ALL co-payments would be suspended for any service, telehealth or in-office; member cost-share will be waived for COVID-19 related services occuring on or after March 18, 2020.   Medicaid, PSHP, PeachCare for Kids 99441-99443

 

Please check the below links for more detail.

Medicaid: https://medicaid.georgia.gov/covid-19

PSHP: https://www.pshpgeorgia.com/newsroom/telehealth-services—covid-19-updates.html

Category

Required Connection

Effective Date

Coverage Period

Member Cost-Share

Billing Guidance

Products Covered

Code Coverage
Telehealth Modalities include telephone communication, use of webcam or other audio and video technology and video cell phone use technology March 20, 2020 June 30, 2020 Waived for testing/treatment related to COVID-19 POS “02”; Modifier “GT” All plans and products Any services that can be delivered virtually will be eligible for telehealth coverage provided the service is “medically necessary”.