Telehealth and COVID-19 update

• 8/24/2020
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PROVIDERS AFFECTED: All providers
 
KEY POINTS:
Updated information on Hennepin Health’s current support of telehealth services and COVID-19 specific codes being used during the pandemic. This bulletin supplies summary information on how Hennepin Health has implemented CMS and DHS updates.

Hennepin Health-telehealth summary

Effective April 1, 2020, Hennepin Health began covering medically necessary services and consultation by providers through telephonic telemedicine in the same manner as if the service or consultation was delivered in person on an interim basis during the coronavirus (COVID-19) pandemic (Minnesota Statutes, 254B.05, subdivision 5(f) and 256B.0625, subdivision 3b). 

Effective April 1, 2020, Hennepin Health included delivery of services through telephone connection between the patient and provider as part of telemedicine services. Telephone services will be allowed for the duration of the coronavirus (COVID-19) pandemic.  

Provider Assurance statements

Hennepin Health requires providers to have submitted Provider Assurance statement for delivery of telehealth services. We utilize the DHS provider enrollment file to verify appropriate assurance statements are in place on the date services are provided.

Providers should complete one of the following forms located on the DHS provider enrollment website and submit to provider enrollment. If you have completed form DHS-6806, you do not need to complete an additional DHS – 6806A form.

• Form DHS-6806 - Providers to complete this form if performing traditional telemedicine services.
• Form DHS- 6806A- Providers to complete this form if they are providing telemedicine via phone with a member who is in their home, nursing home or facility.

Telehealth billing

We recommend that providers bill place of service 02 for services provided via telehealth. CPT code should represent time spent with members.

Providers are to bill Modifier 95 should only be appended to the appropriate CPT or HCPCS code when providing synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.  

Telemedicine (no restrictions during COVID-19 period)

• All Hennepin Health members are eligible to receive telemedicine services.
• Telemedicine services provided to members have no copays / cost sharing.
• The CPT and HCPC codes that describe a telemedicine service are generally the same codes that describe an encounter when the health care provider and patient are at the same site and are billed with place of service 02.
• Telemedicine services are reimbursed for both in-network and out-of-network providers without authorization.
• Telemedicine payment is allowed for one reading/interpretation of diagnostic tests such as x-rays, lab test and diagnostic assessments.
• All mental health services are reimbursable via telemedicine except for children’s day treatment (H2012UA), partial hospitalization (H0035/H0035UA), and mental health residential treatment services (H0019).
• Telehealth providers may not bill condition code DR or modifier CR on telehealth claims during the COVID-19 pandemic period. Providers must continue to use the appropriate telehealth modifiers when billing.
• For ESRD-related services, a physician, NP, PA, or CNS must furnish at least one “hands on” visit (not telemedicine) each month to examine the vascular access site. 
• Both Medicare and Medicaid have more information on their rules and coverage for telehealth and telemedicine services. Refer to their individual websites for more details.
• Hennepin Health began April 1, 2020, covering evaluation and management services provided via telephone using the telephone services CPT codes. Follow CPT guidelines for use of 99441, 99442 and 99443. Providers are not restricted to use of telemedicine CPT codes, and should bill with the most appropriate codes based on time spent with the patient.
  
  

Hennepin Health – Response to COVID-19

Per Families First Coronavirus Response Act, Hennepin Health has waived copays for services related to COVID-19 including testing, diagnostic and treatment services. There are no in-network restrictions for testing, diagnostic or treatment services. 

Providers are advised bill modifier CS for specified COVID-19 testing related services that result in an order for or administration of a COVID-19 test. Lab and diagnostic services are not subject to cost sharing and this will assist in identifying physician services associated with COVID-19 lab testing billed on separate claims. Physician services billed in conjunction with lab services are not required to bill CS modifier. 

Hospital services authorization policy update

• Hospitalization for COVID-19 at non-network hospital will require authorization for stays greater than 10 days. Currently, Inpatient hospitalization stay at non-network hospital facilities require authorization, regardless of length of stay.
• Hospitalization of COVID-19 at in-network hospital facility will require authorization for stays greater than 10 days per current requirements.

All Hennepin Health members do not require authorization to access out-of-network providers for diagnostic testing and outpatient treatment associated with COVID-19.

• Lab, pathology and radiology services are currently open access to all Hennepin Health members. Services provided by out of network labs and radiology departments do not require authorization to pay for services rendered.
• Emergency room and urgent care services are currently open access to all Hennepin Health members (services provided by out of network clinics and facilities for ER and urgent care do not require authorization to pay for services rendered).
• Outpatient hospital visits at non-network providers, non-emergent, will not require authorization for testing, observation and treatment based on COVID or related symptoms billed on the claim.

Billing guidelines

Hennepin Health systems have been updated to accept the following codes.

Reporting changes under Public Health Emergency

Providers may bill the following:

1. The “DR” (disaster related) condition code for institutional billing, i.e., claims submitting using the ASC X12 837 institutional format.
2. The “CR (catastrophe/disaster related) modifier for institutional and non-institutional billing, i.e., claims submitted using ASC X12 837 professional claim format.