The American Medical Association has created a Current Procedural Terminology (CPT) code, 87635, to report laboratory testing services that diagnose the presence of the novel coronavirus.
Medicare Coverage and Payment Related to COVID-19 (CMS 3/5/2020)
Medicaid and CHIP Coverage and Payment Related to COVID-19 (CMS 3/5/2020)
Individual and Small Group Market Insurance Coverage (CMS 3/5/2020)
Go to the TMA COVID-19 Resource Center
The announcement late last month that Medicare will pay for audio-only telehealth visits at the same rate as similar in-person visits was a welcome change for physicians in light of the rapid growth of telemedicine.
The fact that it would be retroactive to March 1 was even better news considering the number of practices struggling with decreased revenue and reduced in-person patient visits.
But one question has remained unanswered: whether Medicare Administrative Contractors (MACs) will automatically reprocess those already-submitted claims, or if physicians will need to resubmit them.
In the wake of COVID-19, TMA is getting calls about which payers are covering telemedicine. TMA developed this quick reference guide to help you navigate telemedicine reimbursement. This table now reflects Medicare’s waiver of the geographic and place of service restrictions for Medicare (which means patients can now be at home).
Additionally, the Governor directed TDI to issue an emergency rule related to the payment of telemedicine to allow state-regulated plans (about 20% of the commercial market in Texas) to allow telephone and telemedicine visits to be paid at the same rate as in-office visits. If you are not sure which patients are regulated by TDI, check this guide. Stay tuned for more detail.
Updated June 3, 2020
Under the sponsorship of county medical societies, TMA staff experts visit county society headquarters for one-to-two-day engagements, providing prescheduled, free half-hour sessions to TMA member physicians and their employees throughout the day. A TMA expert will show you and your staff how to file claims correctly, thus reducing costly delays, resubmissions, and appeals - and possible audits. You can discuss your hassles with Medicare, Medicaid, private payers, and/or workers' compensation, and general payment-related coding and billing questions. Free to TMA members.
Latest tips and information about best billing practices:
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CMS-1500 Claim Form and Instruction Manual - NUCC
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American Medical News
Centers for Medicare & Medicaid Services
Texas Department of Insurance
Texas Medicaid Program
TMA Knowledge Center
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