Telemedicine has taken on a critical role during the COVID-19 public health emergency as health care providers have had to turn to alternative ways of providing health care to limit exposure to the virus. Highmark recognizes the importance of telemedicine at this time to ensure our members are able to access the right care in the right setting to assure safety for all. “Our number one priority – especially during this crisis – is to make sure that our members receive the care that they need,” said Deborah Rice-Johnson, President, Highmark Inc.
To help ensure members can continue to safely receive care, Highmark expanded access to telehealth services for all members and waived out-of-pocket costs such as deductibles, coinsurance, and copayments on all telehealth covered services from March 13, 2020, through September 30, 2020.
Highmark has also expanded access, without out-of-pocket costs, to both in- and out-of-network teleaddiction services for members in Pennsylvania, West Virginia, and Delaware who are in addiction treatment and need immediate help.
To support provider practices and system viability during this time, Highmark has eliminated member cost-sharing for in-network telemedicine services through September 30, 2020, greatly expanded the types of services that are covered via telemedicine, and relaxed the technology standards in our policies for providing telemedicine during the COVID-19 pandemic. “By doing so, Highmark is attempting to make it easier to provide services, eliminate some administrative costs, and potentially avoid the need for investment in technology,” said Robert Wanovich, Vice President, Ancillary Provider Strategy and Management, Highmark Inc.
As Highmark plans for the future of health care beyond the pandemic, we will also continue to evaluate our telemedicine policies, fee schedules, and allowable telemedicine codes. We want to ensure our providers can continue to offer valuable virtual services to our members that are, or will be in the future, equivalent to the standard of care for in-person office visits.
The information below provides a quick overview for providing virtual visits to Highmark members during the COVID-19 public health emergency.
Highmark provides benefit enhancements that give members the option for “virtual visits” with their trusted primary care providers and specialists using real-time interactive audio and video telecommunications technology. These enhancements for virtual visits apply to the PCP/physician office visit, specialist office/outpatient visit and consultation, outpatient mental health, and retail clinic benefits, as applicable, under a member’s benefit plan.
In addition, Highmark also offers a telemedicine benefit through which our members can receive services from one of our approved vendors when they are unable to receive care from their primary care physician or specialist when needed. Services are available through the vendor’s telecommunications platform and performed by practitioners contracted with these vendors.
Virtual visits may be provided by any network participating provider whose services are eligible to be delivered virtually. In general, any provider is eligible to provide covered services within the scope of their license, deemed appropriate using their medical judgment, and delivered within the definition of the code that will be billed. Due to differences in state regulations, certain requirements may vary by state.
The provider can make the determination whether a virtual visit is the right course of treatment for their patient. The standard of care applicable to an in-person patient encounter also applies to a virtual patient encounter. All telemedicine encounter documentation in the medical record is expected to meet the same minimum standards as required for face-to-face visit documentation.
Providers can conduct virtual visits following Highmark’s recommended service and security guidelines using real-time, interactive telecommunications hardware and software that are HIPAA and HITECH compliant. Highmark is not responsible for the security of virtual visits and does not validate the safeguards of any equipment and software used on either side of the virtual transmission.
The U.S. Department of Health and Human Services’ Office of Civil Rights (OCR) announced that it would exercise enforcement discretion and waive potential HIPAA penalties for consumer communication applications if used for telehealth during the COVID-19 nationwide public health emergency.
The OCR’s discretion applies to widely available communications apps, such as FaceTime or Skype, when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19. Through the OCR temporary lift on some restrictions, a provider may use audio and video OR audio only to provide virtual visits to patients using any non-public facing remote communication product that is available.
In line with the OCR’s decision, Highmark is temporarily relaxing its current telemedicine policy requirements as they relate to the specific communication applications used.
Highmark has made modifications to policies and procedures that are in effect through the public health emergency, including allowing some additional services via virtual visits temporarily as part of our response to the COVID-19 crisis. Highmark currently considers the following procedure codes eligible for reimbursement for dates of service from March 13, 2020, through September 30, 2020: Telehealth Code Set .
Please note that, in accordance with the Families First Coronavirus Response Act (FFCRA), Highmark will continue to cover member cost share for COVID-19 related outpatient visits as well as associated services and testing through the end of the public health emergency.
When billing professional (1500/837P) claims, please remember to use the Telehealth Place of Service code 02 for virtual visits using both audio and video components OR audio only. Attach the GT or 95 modifier (whichever best represents the visit) to the procedure code(s) to indicate that the visit was performed via telemedicine using both audio and video components.
On facility claims (UB-04/837I), the facility should use the standard revenue code and CPT/HCPCS codes for the service (service must be listed on the approved telemedicine code list) AND the appropriate 95 or GT modifier should be used to indicate telehealth delivery of services. The use of the 78X revenue code is not required for hospital outpatient telehealth services unless billing Q3014.
Highmark’s virtual visit options were available prior to the public health emergency and will remain as an option for care delivery after the COVID-19 public health emergency ends.
Additional information on virtual visits and the telemedicine benefit is available in the Highmark Provider Manual’s Chapter 2.5: Telemedicine Services . Billing information is detailed in Highmark Reimbursement Policy Bulletin RP-046: Telemedicine Services .
To stay informed, please visit the dedicated COVID-19 section on the Highmark Provider Resource Center regularly for the most up-to-date information related to the COVID-19 public health emergency.
A recorded version of the “Telemedicine and Virtual Visit During COVID-19” webinar presented in May can also be found there.