HealthChoice temporary expansion of virtual services for network providers

HealthChoice takes member health and well-being very seriously. We are closely monitoring the developing effects of the coronavirus (COVID-19) pandemic and how it relates to our providers and members. HealthChoice would like to offer support to our network providers by temporarily expanding coverage for virtual services related to telehealth visits, virtual check-ins and e-visits effective immediately.

The following temporary increases in coverage will be effective for selected services with dates of services from March 6 through June 30, 2020.

COVID-19 testing/office visits
HealthChoice will reimburse at 100% of the HealthChoice allowable amount for the COVID-19 laboratory test and the related office visit charge for both network and non-network providers subject to the following:

• It includes one of the laboratory test codes for COVID-19 as identified by CMS and the AMA (U0001, U0002 and 87635).
• E&M office visit when the visit results in the need for a COVID-19 test. These will be identified by ICD-10 codes Z03.818 or Z20.828.
• Charges for non-network services are subject to balance billing by the provider.
• Any additional services or tests received during the office visit are subject to the patient’s HealthChoice plan’s policy provisions including any applicable copay, deductible and out-of-pocket expenses.

Telehealth
HealthChoice is temporarily expanding benefits to members to include coverage for telehealth services that will be considered the same as an in-person visit. Coverage will include virtual check-ins and e-visits.

Telehealth services
HealthChoice will reimburse at 100% of the HealthChoice allowable amount for both network and non-network providers for an E&M office visit when the visit results in the need for a COVID-19 test. Codes identified in Attachment 1 are included as part of the HealthChoice temporary expansion of telehealth visits.

     •  This benefit is applicable to all HealthChoice plans (including HDHP).
     •  Considered to be the same as an in-person visit.
     •  Requires real-time communication between providers and patients using both audio and video.
     •  Telehealth visits must be billed with place of service (POS) 02.
     •  Reimbursement is applied in accordance with applicable fee schedule criteria under standard methodology.
     •  All current editing guidelines, benefit policies and provisions apply, including certification requirements.
     •  Visits related to COVID-19 testing will be identified by ICD-10 codes Z03.818 or Z20.828.

Virtual check-ins
HealthChoice will reimburse a virtual check-in at 100% of the allowable amount. Charges for non-network visits are subject to balance billing by the provider. High Deductible Health Plan members must meet their deductible before 100% coverage applies, unless the visit is specifically related to COVID-19 testing.

• A virtual check-in is a brief communication between the doctor and patient, can be done via text or email, and does not require both audio and video.
• The following codes are included as part of the HealthChoice temporary expansion for virtual check-in coverage:
  • G2012 BRIEF CHECK-IN BY MD/QHP.
  • G2010 REMOTE IMAGE SUBMIT BY PT.
• Visits related to COVID-19 testing will be identified by ICD-10 codes Z03.818 or Z20.828.
• Certification is not required.

E-visits
HealthChoice will reimburse e-visits at 100% of the allowable amount. Charges for non-network visits are subject to balance billing by the provider. High Deductible Health Plan members must meet their deductible before 100% coverage applies, unless the visit is specifically related to COVID-19 testing.

• E-visits are delivered through a patient portal.
• The following codes are included as part of the HealthChoice temporary expansion for e-visits:
  • 99421 ONLINE DIGITAL E/M SVC EST PT <7 D5-10 MINUTES.
  • 99422 ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES.
  • 99423 ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES.
  • G2061 QUAL NONMD EST PT 5-10 MINUTES.
  • G2062 QUAL NONMD EST PT 11-20 MINUTES.
  • G2063 QUAL NONMD EST PT 21 > MINUTES.
• Certification is not required.
• Visits related to COVID-19 testing will be identified by ICD-10 codes Z03.818 or Z20.828.

If you have questions, please call the medical claims administrator at 800-323-4314. TTY users call 711.

• Attachment_1_ExpansionCodes.pdf