This article was updated on May 28, 2020
Humana will now cover telehealth services for outpatient therapy services provided by physical therapists, physical therapists assistants, occupational therapists, occupational therapy assistants and speech-language pathologists. Humana states they will always follow the Centers for Medicare and Medicaid Services (CMS) telehealth or state-specific requirements that apply to telehealth coverage for our insurance products.
Since CMS now covers telehealth when provided by physical therapists, physical therapists assistants, occupational therapists, occupational therapy assistants and speech-language pathologists in all outpatient therapy settings (both private practice and institutional settings), at minimum, Humana will now cover the same. If state-specific requirements mandate telehealth coverage in additional outpatient therapy settings, then Humana will follow the state-specific requirements and this may then allow reimbursement for telehealth services provided by institutional settings that submit claims on a UB-04 claim form to Humana.
If your state issued an Executive Order that all health plans managed by the state pay for services delivered via telehealth if the same service is a covered benefit when provided in-person, then Humana would be required to pay for outpatient therapy services delivered via telehealth in all outpatient therapy settings.
CPT codes that are payable by Humana when delivered via telehealth by physical therapists, physical therapists assistants, occupational therapists, occupational therapy assistants and speech-language pathologists are the same CPT codes that CMS has approved. The CPT codes approved for telehealth by CMS are 92507, 92521, 92522, 92523, 92524, 92601, 92602, 92603, 92604, 96112, 96113, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760 and 97761.
Since Humana is following CMS telehealth requirements, the place of service (POS) code to use on the 1500-clam form would be the POS code for where the visit would have occurred if not for the COVID-19 pandemic. For example, if the visit would have occurred in-person in a clinic setting, the POS code would be an 11. If the therapist has a mobile private practice where they see patients in their home for outpatient therapy, the POS code would be a 12. On a UB-04 claim, a POS code is not required.
In addition, all providers of telehealth services would need to append modifier 95 to each CPT code on the claim form when delivered via telehealth in addition to any other modifier(s) that may be required that date of service. Per the American Medical Association (AMA), modifier 95 means “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.”
To access the above information as well as additional information straight from Humana, click HERE.[/mepr-show]
I hope you found this article helpful. Thank you for being a Gold Member!
All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.
This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.
Will this be retroactive for the covid-19 shelter-in-place time period?
You would need to look to see when and if an Executive Order was issued by your state and if yes, what is the effective date. The effective date for Medicare for private practice is retro-active to March 1, 2020. If you have additional questions, I would recommend you contact Humana.
Do you know if Humana will continue to cover telehealth therapy services provided by institutional settings that submit claims on a UB-04 claim form to Humana?
Read my latest article at https://gawendaseminars.com/will-commercial-insurance-carriers-reimburse-for-telehealth-after-the-phe-ends/