Please note that the following information applies to Anthem’s Commercial health plans. Please review the Medicare and Medicaid specific sites noted below for details about these plans.


For the latest COVID-19 information, please check our websites often:

Commercial:  Provider News Home

Medicare:  Medicare Advantage Provider News Archives

 

Temporary suspension of Anthem Telehealth Certification requirement

Anthem is temporarily suspending its contractual telehealth certification requirements.  Providers that are eligible pursuant to Connecticut regulatory requirements may also be eligible for telehealth services reimbursement effective March 17, 2020 through March 15, 2021. 

 

Information from Anthem regarding temporary professional telehealth (audio and video) reimbursement rates

Beginning with dates of service on or after March 17, 2020, Anthem will temporarily reimburse covered audio/video telehealth services received from in-network professional providers at the current in-office reimbursement rates. This reimbursement change will remain in effect through March 15, 2021 unless otherwise extended at some future date.

 

Expansion of telehealth (audio and video) codes for physical, occupational, and speech therapists
What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies?

 

Telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT would be appropriate for our fully-insured employer, individual, Individual, Medicare Advantage plans and Medicaid plans, where permissible:

  • Physical therapy (PT) evaluation codes 97161, 97162, 97163 and 97164
  • Occupational (OT) therapy evaluation codes 97165, 97166, 97167 and 97168
  • PT/OT treatment codes 97110, 97112, 97530 and 97535
  • Speech therapy (ST) evaluation codes 92521, 92522, 92523 and 92524
  • ST treatment codes 92507, 92526, 92606 and 92609

 

PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139-97150, 97533 and 97537-97546.

 

Please note that the above information applies to Anthem’s Commercial health plans. Please review the Medicare and Medicaid specific sites noted below for details about these plans.

Commercial:  Provider News Home

Medicare:  Medicare Advantage Provider News Archives

 



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