Administrative Policy effective January 1, 2020

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COVID-19Telehealth Billing Information for NYS OMH Licensed & Designated Facilities

Audience: NYS OMH Licensed & Designated Facilities

The following information is meant to assist you in providing care and easier access to our members during the COVID-19 State of Emergency. We hope that this information helps to address telehealth questions unique to your facility. Telehealth visits are covered for all medically necessary diagnoses (not just those related to COVID-19). There is no member cost-share (i.e., copay, coinsurance, deductible) for any telehealth services during the State of Emergency.

The intent of this notice is to respond to questions unique to OMH licensed and designated facilities regarding the proper modifiers to use for telehealth services. If you have questions about this information, please contact your Behavioral Health Provider Relations representative. 

For all lines of business (commercial, Medicare Advantage, NYS Government Programs and Special Programs) during the COVID-19 State of Emergency, electronic information and communication technologies for telehealth include telephonic and video modalities, including technology commonly available on smart phones and other devices (e.g., Skype, FaceTime, Zoom). These communication technologies may be used when medically appropriate to deliver health care services, without risk of imposed penalties for noncompliance with HIPAA rules. 

Telehealth Reminders

  • A telehealth visit is an option when an in-office visit is not feasible. 
  • Telehealth visits are covered for all medically necessary diagnoses (not just those related to COVID-19) with no member cost-share until the COVID-19 State of Emergency has been lifted. 

Billing Information for Telehealth Services

The appropriate modifier (95 or GT) should be used on claims for services provided via telehealth, when applicable. 

  • 95: Synchronous telemedicine service rendered via a real-time interactive audio and/or video telecommunications system. Appendix P of the AMA's CPT Professional Edition 2019 Codebook provides a summary of CPT codes that may be used for telehealth health services for which the modifier 95 should be used. 
  • GT: Via interactive audio and/or video telecommunications system 

The telehealth modifier should be included after the standard modifier of service. For example, on a claim billing HCPCS code H2017 with modifier EP, the telehealth modifier 95 or GT should be included after the EP modifier, or the standard modifier for the service - H2017 EP 95 (or GT, as appropriate).

When billing for telehealth services, the standard revenue code for the service should be used. When billing with the standard revenue code and modifier for the service, the appropriate telehealth modifier should also be included, when applicable.

Now more than ever, we thank you for the care and dedicated service that you provide to our valued members.

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