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Payments and Telehealth

Payments and Telehealth

The Physical Therapy Association of Georgia is working to keep providers up to date on the most recent payment policy, legislative, and reimbursement news related to COVID-19. Any information contained on this page is provided with the best interest of providers in mind. However, PTAG advocates that every provider should confirm any information with the appropriate legal, regulatory, or payment authorities. This information is changing rapidly, and so it is imperative that you as a provider confirm the information prior to utilizing. This page is intended solely for informational purposes and is not to be construed as advice. Individuals should understand that they must adhere to all federal, state, provincial, and local laws and regulations.

Disclaimer:
The Physical Therapy Association of Georgia (PTAG) makes no representation or warranty as to, and are not responsible for, the contents, validity, or application of the information by any recipient of this material. PTAG does not warrant that the information in this page is free of errors and the entire risk of the use of any information is assumed by the user.

Webinars available - posted 6/22/20

The Department of Community Health (DCH) and DXC Technology invite you to participate in one of the three Appendix K Emergency plan webinars.

 

Now in the third month of the COVID-19 National State of Emergency and following CMS approval of two Appendix K emergency plans, DCH will hold three provider webinars to clarify and respond to questions about several approved waiver operational changes  including:

 

  • The use of retainer payment reimbursement
  • Service delivery in non-traditional settings
  • Staffing by family members as paid caregivers
  • Service delivery while a waiver member is hospitalized
  • Telehealth service delivery allowances

 

Providers are encouraged to send their practice managers, billing staff and business associates, including billing/service agents that submit Medicaid and PeachCare for Kids claims.

 

In order to ensure all Georgia Medicaid providers can attend at least one webinar, there will be three (3) on the dates below.

 

Tuesday, June 23, 2020 at 2pm-3pm

Friday, June 26, 2020 at 10am-11am

Monday, June 29, 2020 at 9am-10am

 

To register online, visit -https://forms.gle/avQSYxnM4mLZaab58. Upon completion of your registration, a confirmation notice will be sent via e-mail to the address provided during registration.  Please review the confirmation e-mail for accuracy.

 

The webinar confirmation e-mail will include:

 

1. Date and time of the webinar workshop

2. Conference phone number and pass code

3. Participant log on key

 

 

Should you have any questions regarding the Emergency Waiver Program Operations: Appendix K Allowances Webinars, please contact DXC Technology via e-mail at GAworkshopregistration@dxc.com.

 


Update 6/9/20

AIM recently published their new PT, OT, SLP guidelines that will become effective October 1, 2020. APTA staff and the APTA Chapter Payment Chairs are working through these. We typically have monthly meetings with AIM and Anthem, these are on hold for the next 2 months but will resume in September. If you have questions or comments, please send them to Payment@PTAGonline.org and we will do our best to address them.

John Wallace PT, Chair, PTAG Payment Policy Committee.

AIM PT OT ST Rehab Guidelines Oct 2020


CMS Update 5/15/20

CMS has issued a transmittal to the MACs instructing that the e-visit codes (G2061-G2013) and virtual check-in codes G2010-G2012) be added to the "Sometimes Therapy" list effective July 6. Up to this point, the MACs, including Palmetto GBA, did not have clear processing instructions for the addition of the GP modifier for the remote patient management codes.  If you have denied claims from Palmetto for these codes, you can re-bill them before July 6 without the GP and CR modifiers or wait and re-bill on or after July 6 using the GP modifier.

Therapy Codes Update - MLN Matters Number: MM11791



Webinar: CPT codes/modifiers PTs can now use for Telehealth for Medicare, May 7

This webinar covered the CPT codes/modifiers PTs can now use for Telehealth for Medicare, documentation requirements, and the known expiration dates for the telehealth exception for the COVID-19 pandemic. We will also had an extended Q and A session for telehealth questions for other payers.

The recording of the webinar can be accessed here.

As discussed on the PTAG Telehealth webinar, the following link is related to the APTA news article that outlines potential flexibility for hospital outpatient department PTs and PTAs related to telehealth, as well guidance on whether PTAs can furnish telehealth in private practices. Read it here.

The most current spreadsheet made by PTAG that outlines our knowledge of payers and their coverage of CPT Codes delivered via telehealth, as well as when the status of any telehealth exemptions apply to (Current as of 5/4/20)
can be found here.


The slides presented in the webinar can be found here.

 



The information  below is believed to be current as of 5/1/2020



CMS Authorizes PT as providers of telehealth

The Basics
  • Physical therapists in private practice are eligible to bill Medicare for certain services provided via telehealth. [Editor’s Note: APTA is seeking confirmation as to whether services furnished by PTAs via telehealth are eligible for reimbursement.]
  • Services that started as of March 1, 2020, and are provided for the duration of the public health emergency are eligible.
  • These CPT codes are eligible to be billed: 97161- 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, and 97761.
  • Patients may be either new or established.
  • These visits are for the same services as would be provided during an in-person visit and are paid at the same rate.
  • Patients may be located in any geographic area (not just those designated as rural), and in any health care facility or in their home.

Here are the codes you can use.
These codes are eligible to physical therapists to furnish and bill under the Medicare Physician Fee Schedule when provided via telehealth:

CPT codes 97161- 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, and 97761. See the full list of codes eligible to be furnished and billed via telehealth under Medicare.

When billing claims for telehealth services provided on or after March 1, 2020, and for the duration of the public health emergency, bill with:

  • Place of Service code equal to what it would have been had you furnished the service in person;
  • Modifier 95, indicating that you did indeed perform the service via telehealth; and
  • The GP modifier.

 

APTA is seeking clarification from CMS regarding institutional billing of telehealth services.

 

PTAG Telehealth and Advocacy Updates: Telehealth post COVID-19

As the current landscape of healthcare and telehealth continues to change, the PTAG Legislative Committee and Payment Policy Committee are beginning to gather data on commercial payers and the current payment for telehealth services. We are currently monitoring when individual payers have stated if any emergency rules related to telehealth services and physical therapy reimbursement will end. We are also monitoring the status of payment for telehealth services. We welcome membership to email our Payment Policy Chair, John Wallace, with any potential updates specific to payer sources reimbursing for telehealth, or any other pertinent information related to reimbursement. John can be reached at payment@ptagonline.org.

Currently, this is what we believe to be true related to the current landscape of telehealth and how long providers have placed exceptions for. We will continue to update membership as we learn more, and advocate on behalf of our members and our patients/clients to receive physical therapy:

Current as of 5/1/2020.
  • Anthem BCBS GA: for cost-sharing waiver: 90 days from 3/17, for Telehealth: 90 days from 3/19
  • Aetna: Telehealth and cost-sharing until June 4, 2020; Medicare Advantage: until further notice
  • UHC: Telehealth and cost-sharing: 3/18 - 6/18
  • CIGNA/ASH: Telehealth and Cost-sharing until May 31, 2020
  • Vantage: We have not found any ending dates called out
  • Humana Military: We have not found any ending dates called out
  • CMS: See the information above related to CMS, Medicare and Telehealth

The Physical Therapy Association of Georgia is working to keep providers up to date on the most recent payment policy, legislative, and reimbursement news related to COVID-19. Any information contained on this page is provided with the best interest of providers in mind. However, PTAG advocates that every provider should confirm any information with the appropriate legal, regulatory, or payment authorities. This information is changing rapidly, and so it is imperative that you as a provider confirm the information prior to utilizing. This page is intended solely for informational purposes and is not to be construed as advice. Individuals should understand that they must adhere to all federal, state, provincial, and local laws and regulations.
 
Disclaimer:

The Physical Therapy Association of Georgia (PTAG) makes no representation or warranty as to, and are not responsible for, the contents, validity, or application of the information by any recipient of this material. PTAG does not warrant that the information in this page is free of errors and the entire risk of the use of any information is assumed by the user.

 


 

The following information was added 4/24/20 regarding Medicaid/PeachCare for Kids Providers:

Telehealth Guidance for Providers - Medicaid 3/18/20

COVID-19 Additional Telehealth Guidance - 4/13/20

 


PTAG Hosting Telehealth Webinar 4/16/20

Payment Policy in Georgia: Updates on Telehealth amidst COVID-19

Information related to Payment Policy at both the state and federal levels continues to change on a minute-by-minute basis amidst the response to COVID-19. Join Daniel Dale, PTAG President, and John Wallace, PTAG Payment Policy Chair, as they provide a webinar on the most recent information at both the Federal and Georgia levels. The session will be recorded and made available on the PTAG website to PTAG members. There will be time for live questions and answers at the end. As a reminder, registration will close after the first 100 attendees sign up. Please consider only signing up if you plan to attend. We would ask that students please consider watching the recorded version so that live seats may be saved for providers needing to ask questions. Thank you for your understanding.

Speakers:
Dan Dale, PT, DPT
John Wallace, PT, MS

The recorded webinar is available here.

The updated presentation slides can be accessed here There was a small typo in the webinar and handout pertaining to specific codes. Please note, on slides 10-13, the codes listed should be G2012 and G2010, not G0201 or  G0210 as listed in the handout. We apologize for the error.  The corrected file is attached above.

The spreadsheet discussed has been updated.  The updated version can be found at the top of this page.


We continue to recommend using the APTA website and references, as it will allow for quicker access to this information at this time and is being updated regularly. It’s likely that as you read this message, some of the news items will have already changed or been clarified, so make sure you reference the APTA page for the latest updates

Resources-

APTA: Click here

CDC: Click here

WHO: Click Here

 


APTA Update: Status of Payers that Cover Telehealth


Please go to the website above and scroll about halfway down to see APTA’s update on the status of payers that are covering telehealth, as well as any information or restrictions that apply. As a reminder, no information is listed for Georgia under “State Emergency Orders Permitting PTs to Provide Telehealth Services” because telehealth is already included as part of our Physical Therapy Practice Act in Georgia.

Straight from the APTA website: “As things rapidly develop regarding the COVID-19 pandemic, mandates and payer policies around telehealth and e-visits are continuously evolving. APTA has developed a series of summaries of the status of federal, state, and commercial payers that are covering some form of telehealth or e-visits during the COVID-19 pandemic, based on information the states and payers have released. APTA will continue to update these resources when new information is confirmed. These are summaries only; refer to the payer policies and state laws for the most accurate and current information.”

 


Language related to Telehealth and the Georgia Telehealth Act of 2019 for Commercial Payers

In 2019, Georgia passed the Georgia Telehealth Act (SB 118, found here: http://www.legis.ga.gov/Legislation/en-US/display/20192020/SB/118 ), which seeks to provide for pay equity for health care providers using telemedicine. As you are aware, the provision of healthcare through telehealth services is part of our state practice act. The above stated law went into effect on January 1, 2020, and so not all commercial payers may be in the habit of allowing for the provision of PT services electronically. We recommend that prior to entering into telehealth services with a client that you check with commercial payers to verify what is and is not permitted by their plan. They may be looking to require services be in real-time or will place other limitations on certain codes or visits related to telehealth. Payers may require some additional documentation or explanations of charges for services.

Additionally, the Georgia Department of Insurance issued an executive order (Item 5 relates to telehealth) in the wake of COVID-19. Please feel free to reference this item when entering into discussion with commercial payers related to telehealth. 

Please let PTAG know by emailing our payment policy chair, John Wallace, at payment@ptagonline.orgif you are made aware of a payer that is not abiding by SB118 so the payment committee can engage them on education or raise the issue to the Department of Insurance. We also ask that you pass information along related to any payers that you are currently working with that are reimbursing for telehealth services for physical therapy at the payment@ptagonline.org email address. 

 


APTA Article: Asking the Right Questions related to Telehealth Reimbursement

 

APTA has released an article related to how to ask the right questions when asking for coverage of telehealth services from providers. When contacting a payer and asking about telehealth coverage and reimbursement, the provider should ask:
  • Will services provided by physical therapists (and PTAs working under the direction and supervision of the PT) be covered when provided via telehealth?
  • If so, what codes should be billed and what modifiers are required?
  • What device(s) or application(s) can be utilized?
  • What, if any, consents are required?
  • Are there any special documentation requirements?