Optometry telehealth billing codes during COVID-19
telehealth billing CV.pdf
VSP telemedicine resources and guidance
{1b040a91-a96c-47da-89c7-72b2538d5552}_Telemedicine_FADTutorial_Final.pdfAOA issues guide to telehealth-based care during COVID-19
During the current public health emergency, many health care providers are turning to telehealth to be able to continue to care for their patients as more patients choose to remain home to reduce community spread of COVID-19. It is important for doctors of optometry to understand the current regulatory framework for the provision of telehealth services; potential state limitations; billing and coding responsibilities as well as malpractice considerations. click here for more.
Expanded telehealth options - Top 5 things you should know
1. California has enacted telehealth payment parity
As a result of COA's advocacy, we were able to get early enactment of a law passed last year to mandate telehealth payment parity. This means health plans must pay for telehealth services at same rate as in person services. Also, COA got an interpretation on the record so that this new law can’t be used to mandate payment for online vision testing. Removing barriers to legitimate telehealth serivces while maintaining the same standard of care will improve access and help ensure that hospitals and health systems can focus on providing care to those who need it most.
2. Medicare has expanded its telehealth services during this crisis.
Medicare will pay for a wider range of telemedicine services during the coronavirus pandemic. That includes remote patient monitoring for both chronic and acute conditions, not just related to coronavirus treatment, and allowing doctors to collect Medicare payments for making phone calls to patients. CMS previously required that consultations have both audio and visual elements.
Additionally, a Medicare beneficiary can now visit with an optometrist without having to go to a health facility.
HHS is using its authority during national emergencies to waive privacy protections so that patients are allowed to video chat with their clinicians on consumer platforms like Google Hangouts and FaceTime.
Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductibles still apply for these services. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for health care providers to reduce or waive cost-sharing for telehealth visits paid by federal health care programs.
For more information, view AOA’s recorded webinar in March & AOA's recorded webinar in April.
3. Medi-Cal also covers telehealth
Medi-Cal providers may utilize existing telehealth policies as an alternative modality for delivering Medi-Cal-covered health care services when medically appropriate as a means to limit patients’ exposure to others who may be infected with COVID-19, as well as to increase provider capacity.
As a reminder, Medi-Cal's telehealth policy gives Medi-Cal providers broad flexibility to determine if a particular Medi-Cal-covered service or benefit is clinically appropriate based upon the individual needs of their patients on a case-by-case basis pursuant to evidence-based medicine and/or best practices.
Medi-Cal covered benefits and/or services, identified by Current Procedural Terminology (CPT) and/or Healthcare Common Procedure Coding System (HCPCS) codes and subject to all existing Medi-Cal coverage and reimbursement policies, including any Treatment Authorization Request (TAR)/Service Authorization Request (SAR) requirements, may be provided via telehealth, as outlined in the “Medicine: Telehealth” Section of the Provider Manual, if all of the following are satisfied:
The treating health care provider at the distant site believes that the benefits or services being provided are clinically appropriate based upon evidence-based medicine and/or best practices to be delivered via telehealth;
The benefits or services delivered via telehealth meet the procedural definition and components of the CPT or HCPCS code(s), as defined by the American Medical Association (AMA), associated with the Medi-Cal-covered service or benefit, as well as any extended guidelines as described in this section of the Medi-Cal provider manual; and,
The benefits or services provided via telehealth meet all laws regarding confidentiality of health care information and a patient’s right to his or her medical information.
Please refer to DHCS’ existing policies relative to telehealth, which are outlined in the following sections of the Medi-Cal Provider Manual: “Medicine: Telehealth,” Federally Qualified Health Centers/Rural Health Clinics,” and Indian Health Services Memorandum of Agreement 638 Clinics.”
The telehealth Frequently Asked Questions document is posted to DHCS’ website.
For managed care plan members, bill and/or submit a referral as indicated per health plan procedures.
if you are not a Medi-Cal provider and want to enroll, click here for emergency Medi-Cal provider enrollment procedures.
4. Billing telemedicine is almost as simple as billing in-person visits
The codes for telemedicine are the same as the codes for in-person visits because the services that you’re providing should be identical.
Bill your office visit code as usual, then add either the GT modifier or the 95 modifier. This varies by payer. You will also change the place of service code from 11 (office) to 02 (telemedicine). For more information about proper billing and coding, visit AOA's webpage.
5. VSP covers telehealth
VSP Vision Care has extended access to its VSP Primary EyeCare Plan services through May for most vision care members and their dependents who are not currently covered with this benefit. VSP will reimburse providers for medical eye care services delivered via telehealth, including specific Evaluation & Management CPT codes and remote retinal imaging services, with appropriate modifiers to indicate the modality it was rendered (synchronous/asynchronous). These codes allow the provider to treat a patient without face-to-face interaction for medical issues such as conjunctivitis. For a complete list of covered services, please refer to the Provider Reference Manual on VSPOnline at eyefinity.com and navigate the Plans and Coverage area to access the VSP Primary EyeCare Plan page.