New Telehealth Payment Policy to Replace Interim COVID-19 Policy
In the early days of the COVID-19 pandemic, CarePartners of Connecticut instituted an interim payment policy to address the unique needs of our providers and members during the unprecedented public health crisis. The Temporary COVID-19 Telehealth Payment Policy was developed to temporarily replace the previously existing policy, expand the scope of coverage during the pandemic, and offer guidance on coverage and billing.
For dates of service beginning Sept. 1, 2022, this interim policy will be retired, and CarePartners of Connecticut’s new Telehealth/Telemedicine Payment Policy will take effect.
With the implementation of the new policy, we will introduce a number of claim edits, which are intended to support industry standard correct coding principles and will not apply a reduction in payment. (All telehealth services will continue to be reimbursed at parity.)
CarePartners of Connecticut will deny any procedure code that is billed with place of service (POS) 02 (telehealth services rendered in a location other than the patient’s home) or POS 10 (telehealth services rendered in the patient’s home) if an appropriate telehealth modifier is not also appended to the claim. We will also deny any procedure code appended with a telehealth modifier when POS 02 or POS 10 is not also reported.
Keep in mind that a telehealth modifier should not be appended when billing codes with “telehealth” or “telephone” are in the description — such as Q3014 (Telehealth originating site facility fee), 98966 (Telephone assessment) or 99441 (Telephone evaluation and management) — as billing one of these procedure codes inherently indicates that the service was provided via a telehealth modality. These services should be reported with the applicable POS only.
As a reminder, CarePartners of Connecticut will deny a telephone service when it is billed on the same day as a face-to-face evaluation and management (E/M) service, as the telephone encounter is considered part of the pre-service work associated with the face-to-face E/M service. CarePartners of Connecticut will also deny a telephone service when a face-to-face E/M service was performed in the previous seven days, because the telephone encounter would be considered part of the previous service.
Please refer to the new Telehealth/Telemedicine Payment Policy (effective for dates of service on or after September 1, 2022) for complete information. The new payment policy includes details about how CarePartners of Connecticut defines telehealth/telemedicine, a list of telehealth modifiers, reimbursement criteria, examples of services that will and will not be reimbursed, and more.