Telemedicine for Medicare Members
During the current State of Emergency related to COVID-19, telemedicine visits for Medicare Members will be paid at the same rate as if the visit was in person. Effective March 13, 2020, telemedicine visits billed with codes 99201-99215 with the POS code that would have been reported had the services been furnished in person, and the appropriate appended modifier, “95” or “GT”, will be reimbursed at no cost-share to the Member. This applies to all services (E/M, Mental Health Counseling, and preventive services) that would have otherwise been face-to-face.
The following modifications have been made for the duration of the declared State of Emergency
- Location restrictions on Originating Sites: Medicare Members can be in their home for the telemedicine visit
- Providers may conduct telemedicine visits with a Member that is not already established (new patients)
Providers must use an interactive audio and video telecommunications system that permits real-time communication between the Provider (“Distant Site”) and the Member (“Originating Site”). When it is possible for Covered Services to be furnished via telemedicine, MVP will pay for such services. Such services should be coded at a level of care appropriate for provision through a telemedicine mechanism. Providers should maintain documentation in the medical record for the level of care billed. MVP may request additional documentation to review and confirm such level of care.
The following new codes should be used for telephone visits with Medicare Members to ensure cost-share is waived. More information about the Interim Final Rule can be accessed from the Federal Register’s website.