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Telemedicine Services During the COVID-19 Crisis

NEW TELEHEALTH POLICIES EXPAND COVERAGE FOR HEALTHCARE SERVICES

In order to ensure that all of our members have needed access to care, we are increasing the scope and scale of our use of telehealth services for all products for the duration of the COVID-19 emergency.  These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to avoid clinical settings and other public spaces.

Effective immediately, the policies we are implementing include:

  • Continuation of zero member liability (copays, cost sharing, etc.) for care delivered via telehealth*
  • Any services that can be delivered virtually will be eligible for telehealth coverage
  • All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020 through July 25, 2020
  • Telehealth services may be delivered by providers with any connection technology to ensure patient access to care

*Please note: For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telehealth/telemedicine related services. 

Providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state. For further billing and coding guidance for telehealth services, we recommend following what is being published by:

We believe that these measures will help our members maintain access to quality, affordable healthcare while maintaining the CDC’s recommended distance from public spaces and groups of people. 

This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.

Updated 5.15.2020

Telehealth Expansion (updated 4.7.2020)

Click the link above to visit the Telehealth Expansion section on the Coronovirus FAQs page

Oregon Health Authority Resources for OHP/Medicaid

Oregon Health Plan coverage of telephone/telemedicine/telehealth services (PDF)

Information for Oregon Health Plan physical and behavioral health providers

Medicare Resources from CMS

 

Type of Service What is the Service HCPCS/CPT Code Patient Relationship with Provider
MEDICARE TELEHEALTH VISITS A visit with a provider that uses telecommunication systems between a provider and a patient.

Common telehealth services include:

  • 99201-99215 (Office or other outpatient visits)
  • G0425-G0427 (Telehealth consultations, emergency department, or initial inpatient)
  • G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs)

Complete list of CMS codes

For new* or established patients.

*To the extent of the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public emergency.

VIRTUAL CHECK-IN A brief (5-10 minutes) check in with your practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.
  • HCPCS code G2012
  • HCPCS code G2010
For established patients.
E-VISITS A communication between a patient and their provider through an online patient portal.
  • 99421
  • 99422
  • 99423
  • G2061
  • G2062
  • G2063

Effective 3/30:

  • 99441
  • 99442
  • 99443
  • 98966
  • 98967
  • 98968
For established patients.

Teladoc Telemedicine/Telehealth Services

Yes. Consistent with recommendations from the CDC, if the doctor observes symptoms and risk factors that suggest COVID‐19, s/he now has the ability to add a notation to the “excuse note” advising the patient to self‐quarantine for 14 days. (Clients continue to have the ability to suppress excuse note capabilities at the group level.)

No. Given demand for medical care during this outbreak, we are not able to re‐evaluate healthy patients and issue return‐to‐work notes.

Yes. During the COVID‐19 outbreak, our doctors have the ability to approve 30‐day prescription refills for chronic conditions whenever medically appropriate to do so. Maximum prescription refill duration will be 90 days. Physicians continue to evaluate clinical appropriateness, consider patient safety, and use professional judgement when approving any refill requests.

Suspected cases are coded using ICD‐10‐CM codes related to the upper respiratory and related symptoms observed and, as applicable, secondary ICD‐10‐CM codes including: Z20.828 for “Contact with and (suspected) exposure to other viral communicable diseases,” Z20.89 for “Contact with and exposure to other communicable diseases,” Z20.9 for “Contact with and exposure to unspecified communicable disease,” Z71.1 for “Person with feared health complaint in which no diagnosis is made,” or Z71.89 for “Other specified counseling.”

All patient consults are now screened for COVID‐19 symptoms and risk factors. Teladoc Health care providers are evaluating symptoms (e.g. fever, cough, shortness of breath) and contact history (e.g. known exposure to a person diagnosed with COVID‐19, recent travel or living in an area with an active

outbreak, healthcare worker who may have increased risk of exposure) to assess COVID‐19 risk. If the doctor gathers information that suggests risk of COVID‐19, we will help guide patients to the next step for care and testing as follows:

In accordance with evolving local guidance, we will contact the appropriate public health department. Each public health department defines its own parameters regarding how they will implement testing, conduct contact tracing, and/or implement at‐home self‐monitoring, at home supervised isolation, or quarantine requirements.

HOME CARE: While no specific treatment for COVID‐19 infection is indicated at this time, Teladoc Health care providers will provide up‐to‐date, evidence‐based supportive care to relieve symptoms for affected patients, addressing both physical and mental health needs. Most cases will be mild and safely managed via an at‐home care plan. Home care will greatly reduce the chances of viral spread. Patients are encouraged to contact us again, should they have follow‐up questions, or in the event that their symptoms progress.

IN‐PERSON TESTING: Many health departments and health systems are prioritizing testing for patients with the greatest risk of COVID‐19 complications or greatest risk of spreading to others. When our doctors identify a COVID‐19 suspected case, we advise individuals to call their local doctor or their state’s public health hotline to verify test availability and to “let them know before you go” so that the in‐person care facility can direct them appropriately and minimize potential exposure for others.

IN‐PERSON CARE: For cases where in‐person care is needed, we will navigate patients to appropriate resources and encourage patients to “let them know before you go” so that the in person care facility can direct them appropriately and minimize potential exposure for others. If the patient needs to be seen and cannot manage on their own, we will follow 911 protocol and our 24/7 support team support the physician and patient and EMS to communicate that the patient could have COVID‐19.

Due to high demand for healthcare, people are experiencing longer than usual wait times – both at in person care sites in their communities and at Teladoc. We are closely monitoring visit request volumes and activating physicians to serve surges in demand. We expect that healthcare needs will continue to escalate, so we are helping our clients and members to prepare as follows:

  • If you’re new to using Teladoc, start by visiting our website for answers to frequently asked questions.
  • For fastest support, we encourage members to contact Teladoc by mobile App or web. You can download the App on the App Store or Google Play.
  • Before their first virtual visit, members need to set up a Teladoc account and share their medical history on the app or on our account set up page. Completing this step in advance accelerates visit requests.
  • We recognize that unexpected wait times can be frustrating, especially when you’re not feeling well, so we have updated our phone, web, and App messaging to help people understand that we are experiencing higher than usual call volumes. On the Teladoc website and App, our wait time estimator helps members to anticipate the expected time for a callback from a doctor.

We are grateful for and impressed by the dedication of our doctors who are passionate about taking care of people and are eager to help serve rising demand – and the Teladoc Health Medical Group is continually recruiting and onboarding high‐quality physicians to our growing network.

With years of virtual care experience, our clinical operations team has developed staffing models that factor trends by month, day, and time of day, as well as unique geographic considerations. We are working closely with the CDC to monitor the outbreak and we are leveraging this insight, along with our knowledge of plan sponsors’ communications and member co‐pay adjustments, to forecast likely demand for virtual care services.

As COVID‐19 demand increases, we are activating doctors with proven outreach and incentive strategies to serve needs in a timely manner. Our provider relations and engagement teams implement targeted campaigns to educate, motivate, and appreciate doctors and to encourage active participation on our platform.