By Carol Hoppe, CPC, CCS-P, CPC-I
MedLucid Solutions, LLC

ISMA’s advocacy has helped bring about an important change in billing for telehealth services for Indiana Medicaid fee-for-service (FFS) and managed care plans. And, Anthem, Inc. recently announced updates regarding telehealth services and cost-share waivers.

ISMA action spurs IHCP telehealth billing change

Indiana Health Coverage Programs (IHCP) has announced an important change in billing for telehealth services for Indiana fee-for-service (FFS) and managed care plans.

After several complaints from providers who noted that the Anthem HIP refused to reimburse at the non-facility rate with POS 02 and modifier 95, the ISMA appealed to the FSSA’s Office of Medicaid Policy and Planning (OMPP) for assistance. The result is the new bulletin quoted below. This change means that you should now bill with POS 11 and modifier GT for all Medicaid plans.

“These changes are required as of October 24, 2020, and through the duration of the public health emergency. However, providers may take advantage of these changes immediately by billing as described, beginning with claims for dates of services (DOS) on or after September 24, 2020.

“To better align with temporary Medicare billing guidance issued in response to COVID-19, providers must bill for services rendered through telemedicine using the place of service (POS) code that would have been reported had the service been furnished in person, and modifier GT – Via interactive audio and video telecommunication systems. This change applies only to professional claims (CMS-1500 claim forms, IHCP Provider Healthcare Portal professional claims, and 837P electronic transactions). Additionally, this change ensures that providers are reimbursed for services rendered through telemedicine at the same rate as if services were provided in-person.”

Unfortunately, there is no mention of any retroactive corrections, but at least for the remainder of the public health emergency, physicians can expect to be paid equitably for Anthem HIP patients.

Anthem extends telehealth coverage, cost-share waivers

Anthem recently issued the following bulletin regarding telehealth and telephonic-only visits:

Telehealth (video plus audio)
For COVID-19 treatments via telehealth visits, Anthem’s affiliated health plans will cover telehealth and telephonic-only visits from in-network providers and will waive cost shares through Dec. 31, 2020.

Effective from March 17 through Sept. 30, 2020, Anthem’s affiliated health plans will waive member cost shares for telehealth visits from in-network providers, including visits for mental health or substance use disorders, for our fully-insured employer plans and individual plans. From March 17 through Dec. 31, 2020, Anthem will waive member cost shares for telehealth visits from in-network providers, including visits for mental health and substance use disorders, for our Medicare Advantage and Medicaid plans, where permissible.

For out-of-network providers, Anthem is waiving cost shares from March 17 through June 14, 2020. Cost sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video plus audio services. We encourage our self-funded customers to participate, and these plans will have an opportunity to opt in.

Telephonic-only care
Effective from March 19, 2020 until further notice, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers. Out-of-network coverage will be provided where permissible. This includes covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Cost shares will be waived for in-network providers only until Sept. 30, 2020. Self-insured plan sponsors may opt out of this program.

These changes are included in ISMA’s updated Telehealth Coding Summary / Coverage Dates table at here.