MMO Broker Update – Telehealth/Telemedicine Coverage

Important Clarifications on Telehealth (Telemedicine) Coverage
Date: March 24, 2020
Category: News
Applies to: All

In efforts to help slow the spread of the coronavirus disease known as COVID-19, health professionals and their patients may turn more frequently to the use of telehealth (telemedicine) visits. Please review the summaries below: to better understand the coverage for these services.

Telehealth (telemedicine) visits (covered by all plans)

  • Telehealth (telemedicine) visits are primarily scheduled visits between patients and healthcare providers with an established relationship, and may be handled by computer, tablet or smartphone.
  • Telehealth (telemedicine) visits are for patients needing routine care for chronic or general health conditions. They are covered just like any other medically necessary office visit.
  • They are billed with office visit codes; modifiers are not required.
  • Behavioral health visits are included.

On-demand virtual visits (covered by most plans)

  • On-demand virtual visits are a subset of telehealth (telemedicine). These types of visits typically include 24/7 virtual access to licensed healthcare professionals with whom the patients do not have an established relationship.
  • They are similar to visits to an urgent care facility and are typically needed due to an acute health issue.
  • Visits are typically covered like primary care provider visits unless otherwise specified.
  • Behavioral health visits are not covered as on-demand virtual visits.
  • Examples of plan-specific covered on-demand virtual visit providers include the Cleveland Clinic’s Express Care online services and Teladoc.

If you have any questions about telehealth (telemedicine) benefits, please contact your Cornerstone Senior Marketing Representative