Telephone-Only Consultation Coverage and Payment Vary
By Ellen Terry

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The use of telemedicine has been expanded so physicians can safely and effectively treat patients during the COVID-19 pandemic. 

However, some people don’t have smartphones with video capability, meaning visits will have to be done via old-fashioned phone calls. 

Which health plans cover telephone-only patient visits, and what exactly do they pay for? 

Some payers offer temporary, limited coverage of telephone-only visits during the COVID-19 crisis. However, not all cover audio-only evaluation and management (E&M) services. 

Below is a summary of which plans pay for audio-only services: 

Commercial Payers

Aetna: Until Aug. 4, Aetna will cover minor acute E&M services provided via telephone. A visual connection is not required for services with these codes: HCPCS virtual check-in code G2012 and CPT E&M codes 99441-99443. Virtual check-ins are for patients with an established relationship with a physician, where the communication is not related to a medical visit within the previous seven days and does not lead to a medical visit within the next 24 hours (or soonest appointment available). The patient must verbally consent to receive virtual check-in services. 

Blue Cross and Blue Shield of Texas: BCBSTX will cover audio-only consultations through July 31 for state-regulated fully insured HMO and PPO plans and through Dec. 31 for Medicare and Medicaid plans when provided in accordance with applicable regulations and rules. BCBSTX will recognize CPT codes 99201-99215, place of service 02, for these consultations, with applicable modifiers -95, -GQ, or -GT. BCBSTX also covers telephone evaluation codes 99421-99423. This policy applies to claims with dates of service on or after March 20.

Cigna: For brief (5-10 minutes) phone calls with established patients to determine whether an office visit or other service is needed, Cigna will pay for HCPCS virtual check-in code G2012 without customer copay or cost share. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults at least through July 31. Visit Cigna’s secure provider website for details. 

Humana: For physicians or patients without access to secure video systems, Humana will temporarily accept telephone (audio-only) visits; these visits can be billed as telehealth visits. 

UnitedHealthcare: For commercial, Medicaid managed care, and Medicare Advantage members, UnitedHealthcare pays for HCPCS virtual check-in code G2012 as well as CPT E&M codes 99211-99215. For audio and video telecommunications during the public health emergency, the requirement for a preexisting patient relationship has been waived. UnitedHealthcare will extend the expansion of telehealth services for in-network physicians, for both Medicare and fully insured individual and group plans, through Sept. 30, and for out-of-network physicians through July 24. The payer's Medicaid plans follow Texas Health and Human Services Commission guidance.

Government Payers

Medicare will cover audio-only CPT telephone codes 99441-99443 (provided by a physician) and 98966-98968 (provided by a qualified nonphysician professional) for new and established patients, in addition to HCPCS virtual check-in codes G2012. Effective March 1 and throughout the national public health emergency, Medicare will pay physicians for audio-only telehealth services at the same rate as in-office visits for all diagnoses, not just COVID-19-related services. Payment for codes 99441-99443 is equal to Medicare’s established in-person visit codes (99212-99214).

Medicaid and Medicaid managed care organizations (MCOs) will pay for audio-only telephone consultations as authorized by the Texas Medical Board, for services delivered March 20 through July 31. The Texas Health and Human Services Commission said covered E&M CPT codes are 99201-99205 and 99211-99215 and should be billed with the -95 modifier. This policy applies to physicians who participate in Healthy Texas Women and the Family Planning Program. Medicaid and Medicaid MCOs also will pay for certain behavioral health services provided over the telephone.  

To guide physicians who are interested in using telemedicine, the Texas Medical Association has published a TMA Practice Well podcast about adopting telemedicine. In addition, the TMA COVID-19 Task Force has published a document to help you get started with telemedicine.

Find the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.

CPT copyright American Medical Association. All rights reserved. 

Last Updated On

June 29, 2020

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Ellen Terry

Project Manager, Client Services

(512) 370-1391

Ellen Terry has been writing, editing, and managing communication projects at TMA since 2000. She hails from Victoria, Texas; has a journalism degree from Texas State University; and loves to read great fiction. Ellen and her husband have two grown sons and a couple of cats.

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