The Michigan Physical Therapy Association (MPTA) has updated their website with information stating “BCBSM has notified MPTA that it will cover CPT Codes 97110, 97112, 97116, 97530 and 97535 via telehealth effective for both commercial and MA population until June 30. The official notification and associated nuances/restrictions will be posted on the Provider Portal soon.”
Effective immediately, all health plans in the state of California shall comply with the following:
- Health plans shall reimburse providers at the same rate, whether a service is
provided in-person or through telehealth, if the service is the same regardless of
the modality of delivery, as determined by the provider’s description of the
service on the claim. For example, if a health plan reimburses a mental health
provider $100 for a 50-minute therapy session conducted in-person, the health
plan shall reimburse the provider $100 for a 50-minute therapy session done via
- For services provided via telehealth, a health plan may not subject enrollees to
cost-sharing greater than the same cost-sharing if the service were provided in-person.
- Health plans shall provide the same amount of reimbursement for a service
rendered via telephone as they would if the service is rendered via video, provided the modality by which the service is rendered (telephone versus video is medically appropriate for the enrollee.
Effective March 19, 2020, all outpatient rehabilitative settings shall close and transition to a telehealth platform in accordance with DMS guidance immediately. Click HERE to read it straight from the Governor.
Skilled rehabilitation professionals (physical therapists, occupational therapists, speech language
therapists, and respiratory therapists) shall continue to work in acute care, inpatient rehabilitative
settings, and skilled nursing facilities. Their work will allow patients to heal sooner and return home to their preferred setting. All CDC recommended protective measures shall be in place when providing services to patients.
Home health rehabilitation professionals shall use best clinical judgment to determine best practice
for the implementation of community based rehabilitative services in light of the COVID19 pandemic. In-home rehabilitative services shall be extremely limited and medically necessary to prevent readmission to an acute care or long-term care setting.
Rehabilitative telehealth services shall be maximized to the fullest extent possible for patients
receiving community based rehabilitative skilled therapy services.
Does UnitedHealthcare (UHC) pay for telehealth for outpatient physical, occupational and/or speech therapy services?
Does UnitedHealthcare (UHC) pay for E-Visits under outpatient physical, occupational and/or speech therapy services?
Can I charge UnitedHealthcare (UHC) patients cash for telehealth services if not covered by their plan?
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Does TRICARE pay for telehealth services for outpatient physical, occupational and/or speech therapy services?
What CPT code(s) do I use to bill for telehealth for TRICARE beneficiaries?
The TRICARE Policy Manual is not clear on what code(s) to use for telehealth services. Your first option is to contact TRICARE.
Per the TRICARE Policy Manual, April 2015, Change 60 (March 13, 2020), Chapter 7, Medicine, Section 220.127.116.11, it states the following: “When billing for synchronous telemedicine services, providers will use CPT or HCPCS codes with a GT modifier for distant site and Q3014 for originating site to distinguish telemedicine services. In addition, Place of Service POS 02 is to be reported in conjunction with GT modifier. By coding and billing the GT modifier with a covered telemedicine procedure code, the distant site provider certifies that the beneficiary was present at an eligible originating site when the telemedicine service was furnished.”
TRICARE may or may not pay for the CPT codes commonly used by physical therapists, occupational therapists or speech-language pathologists that are found in the 92000 and 97000 series when billed with the GT modifier and Place of Service code 02.[/restrict]
Is preauthorization required for telehealth services?
If I have additional questions or I want to contact my TRICARE Regional Contractor, how can I do that?
TRICARE has 2 Regional Contractors. Health Net Federal Services is responsible for the West Region and Humana Military is responsible for the East Region.
I hope you found this article helpful. Thank you for being a Gold Member!
In a memorandum dated March 17, 2020, the state of Louisiana, Louisiana Department of Health, Bureau of Health Services Financing, announced “Effective for dates of service on or after March 17, 2020, and for the duration of the COVID-19 emergency, Louisiana Medicaid encourages and will reimburse the use of telehealth, when appropriate, for rendering physical therapy, occupational therapy, and speech therapy to members. Telehealth can facilitate the continuation or establishment of these services while complying with the need for social distancing”.
To read the entire memorandum, click
This is a tremendous opportunity for therapists in the state of Louisiana and for your Medicaid patients. Thank you for being a Gold Member!