Telehealth Reimbursement – Pennsylvania American College of Physicians

Most of the states in the MATRC region (DC, DE, KY, MD, NJ, VA) have passed “parity legislation”,  meaning that if a service being provided and billed for is considered a covered service in a face to face situation, a commercial carrier may not deny coverage solely because the service was provided via telehealth.

A few states in the MATRC region do not have parity legislation (NC, PA, WV).   For these states, it is up to the carrier to set its own policies regarding coverage.  In this case, you  would need to contact each commercial payer to ascertain their coverage policy.  In response to the pandemic, several health plans that serve our region have announced that they will make telehealth more widely available or are offering telehealth services for free for a certain period of time.  These are the ones that have come to our attention to date:
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• Aetna – COVID-19 Service Enhancements
• Aetna – COVID-19 Approved Behavioral Health Telemedicine Services
• AmeriHealth New Jersey – COVID-19 Service Enhancements
• Anthem – COVID-19 Service Enhancements
• Blue Cross and Blue Shield Companies – COVID-19 Service Enhancements
• Blue Cross and Blue Shield of North Carolina – COVID-19 Service Enhancements
• Blue Cross and Blue Shield Federal Employee Program – COVID-19 Service Enhancements
• Capital Blue Cross – COVID-19 Service Enhancements
• CareFirst – COVID-19 Service Enhancements
• CareFirst BlueCross BlueShield – COVID-19 Service Enhancements
• Centene – COVID-19 Service Enhancements
• Cigna – COVID-19 Service Enhancecments
• Geisinger Health Plan – COVID-19 Service Enhancements
• Highmark – COVID-19 Service Enhancements
• Horizon Blue Cross Blue Shield of NJ  – COVID-19 Service Enhancements
• Humana – COVID-19 Service Enhancements
• Magellan Health – COVID-19 Service Enhancements
• United Health Care – COVID-19 Telehealth Services

Not all commercial carriers have the same schema regarding modifiers or POS codes.  If guidance about billing codes is not provided in the above links and/or if your plan is not listed above, you will unfortunately need to contact each plan to find out which modifer or POS codes that they want you to use to indicate a telehealth visit.