Telehealth
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. COA also 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.
Billing for Telemedicine
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).
telehealth billing CV.pdfVSP Covers Teleheath
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.
Insurance Liability
Does your professional liability (malpractice) insurance policy cover telehealth services?
The COA-endorsed professional liability insurance brokered by Mercer and underwritten by Liberty Insurance does not include any exclusions of coverage for vision telehealth services provided by doctors of optometry.
The COA-endorsed professional liability insurance brokered by Mercer and underwritten by Liberty Insurance provides comprehensive coverage that aligns with the services that doctors of optometry provide to their patients within their state's defined scope of practice.
If you do not have the COA-endorsed professional liability insurance, you may want to take the following actions:
Ask your insurance provider whether vision telehealth services are covered by your policy. If you are told that vision telehealth services are covered, then make sure to ask your insurance provider to show you where it explicitly says in your policy that you are covered for vision telehealth services.
In addition to asking your insurance provider to show you proof of coverage for vision telehealth services, it is also good practice to review the exclusions and endorsements in your policy to ensure there is no language limiting or omitting vision telehealth services.
Ask your insurance provider whether you are covered for the full scope of coverage defined by the CA Board of Optometry.