With the COVID-19 pandemic keeping many Americans home, telehealth services have emerged as an alternative to in-person care.
Prior to this telehealth was an option for some medical services, however most insurances did not cover physical, occupational and speech therapy delivered by this method.
Telehealth is not a new concept. In fact, in the early 1900s when radio revolutionized communication it wasn’t long before innovators started imagining how doctors could attend to patients over the radio. In 1924 a radio news magazine featured an illustration of a doctor attending to a patient via video call, under the headline “The Radio Doctor–Maybe!”. During the1940s radiology images were sent 24 miles between two townships via telephone line in the world’s first example of an electronic medical record transfer. A Canadian doctor built upon this technology in the 1950s, constructing a teleradiology system that was used in and around Montreal. As these practices became more widespread, so did motion pictures, and with the advent of modern film technology came serious plans for video medicine. The first people to use video communication for medical purposes were clinicians at the University of Nebraska. In 1959, the university established a two-way television setup to transmit information to medical students across campus, and five years later linked with a state hospital to perform video consultations.1
Since then telemedicine has grown and expanded. Patients and the medical community have seen the advantages of conducting these types of visits. As per Sloan Kettering, these include:
- Getting the care you need without having to travel to the hospital/clinic.
- Saving travel time and money.
- Helping you spend less time at your healthcare provider’s office.
- Not having to have a caregiver travel with those who can not transport themselves
“During this global pandemic, telehealth is emerging as an effective and sustainable solution for precaution, prevention and treatment to stem the spread of COVID-19. Telehealth is bridging the gap between people, physicians and health systems, enabling everyone, especially symptomatic patients, to stay at home and communicate with physicians through virtual channels, helping to reduce the spread of the virus to mass populations and the medical staff on the frontlines, said Dedi Gilad, CEO and co-founder of Tyto Care, a telemedicine technology company. Critically, hospitals are quickly adopting telehealth to treat quarantined patients infected with COVID-19.”2
The American Physical Therapy association has been a long time advocate for physical therapists and physical therapists assistants providing services via telehealth. From their position to the House Of Delegates (TELEHEALTH HOD P06‐19‐15‐09 [Initial: HOD P06‐14‐07‐07] [Position]):
“Telehealth is a well defined and established method of health services delivery. Physical therapists provide services using telehealth as part of their scope of practice, incorporating elements of patient and client management as needed, to enhance patient and client interactions. The American Physical Therapy Association (APTA) supports:
∙Inclusion of physical therapist services in telehealth policy and regulation on the national and state levels to help society address the growing cost of health services, the disparity in accessibility of health services, and the potential impact of health workforce shortages;
∙Advancement of physical therapy telehealth practice, education, and research to enhance the quality and accessibility of physical therapist services; and
∙Expansion of broadband access to provide all members of society the opportunity to receive services delivered via electronic means.
With these advantages, support of governing bodies and the technology being quickly put into place, many clinicians wonder if after the pandemic this option will remain. Many insurances have put an end date in place for coverage, however there is some speculation that these will be extended or removed.
In May of 2020 BlueCross BlueShield of Tennessee announced that it is making coverage of in-network telehealth service a permanent part of its benefit packages, including telehealth delivered by physical therapists, occupational therapists and speech therapists. The was the first time a major insurer has extended telehealth coverage beyond the length of the current public health emergency. It’s telehealth coverage includes both member-to-provider and provider-to-provider consultations, and it has seen health care providers across Tennessee demonstrate increasing support for these services.
At the beginning of October two Pennsylvania-based companies announced that they permanently will include physical therapists among the providers who can bill for services delivered via telehealth, moving beyond temporary provisions adopted in response to the coronavirus pandemic. Pennsylvania-based AmeriHealth Caritas and Independence Blue Cross recently issued information on the shift, which will be put in place beginning Jan. 1, 2021. The companies serve a large base within the state with Independence Blue Cross being the largest health insurer in the Philadelphia area, serving about two million people in the region, while AmeriHealth Pennsylvania is a managed care health plan serving 200,000 people across the Lehigh and Northwest regions of Pennsylvania.
Both companies are following these guidelines:
- Patients must be established patients.
- The following CPT codes will be covered when the services are provided via telehealth: 97110, 97112, 97116, 97161, 97162, 97164.
- For providers who bill on a UB04, only the following revenue codes will be permitted for telehealth: 0423, 0424, 0429.
- Telemedicine services must take place via a secure HIPAA-compliant telecommunications system using interactive, synchronous (real-time) two-way audio and video communications.
- Providers must report the appropriate modifier (GT or 95) and place-of-service code 02 (Telehealth) to represent telemedicine services.
- For members enrolled in HMO or HMO-POS plans with primary care provider capitation, any capitated services, which include physical therapy, must be referred to the primary care provider’s designated capitated sites.
- Applicable member cost-share provisions will be applied.
Here are some services that will not be covered if delivered via telehealth beginning on January 1, 2021:
- The following codes: 97129, 97130, 97163, 97166, 97167, 97530, 97533, 97535, 97542, 97750, 97755, 97760, 97761, 97129, and 97130.
- Communication technology-based codes (G2010, G2012, G2061, G2062, G2063) and telephone codes (98970, 98971, 98972).
- Services billed under UB04 revenue codes 0420, 0421, 0422, 0424.3
As has been the theme of 2020, providers are encouraged to stay up-to-date of the rapidly changing rules and regulations of each insurance as well as their state practice act.