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Extending Reimbursement, Cost-Share Waiver for COVID-19 & non-COVID-19 Telehealth Services

Audience: Providers, Hospitals and Certified Home Healthcare Agencies

Please review the important updates below related to our extension of the member cost-share waiver and continued provider reimbursement for COVID-19 and non-COVID-19 telehealth services.

We will continue to monitor the federal public health emergency and the New York State executive order to determine if further extensions are needed.

If you have questions regarding this information, please contact your Provider Relations representative.

Update Regarding Reimbursement for Telehealth Services

  • For all lines of business, we will continue to reimburse all telehealth services at the same rate as the corresponding face-to-face CPT/HCPCS code through the end of the federal public health emergency (which was recently extended to October 23, 2020) or December 31, 2020, whichever comes later.

  • We will determine an appropriate level of reimbursement for telehealth services for 2021 and will provide advance written notice of any changes.

Member Cost-Share for Telehealth Services

COVID-19 Related Telehealth Services:

  • In accordance with federal regulations, COVID-19-related services provided via telehealth must be covered in full with no member cost-share through the end of the federal public health emergency (which was recently extended to October 23, 2020).

COVID-19 and Non-COVID-19 Related Telehealth Services:

  • In accordance with the NYS executive order, for members covered by commercial fully insured products and members enrolled in self-funded groups that have not opted out of waiving member cost-share, all telehealth services (COVID-19 and non-COVID-19) must be covered in full with no member cost-share through the expiration of the NYS executive order (which is currently slated to expire on September 9, 2020; date subject to change). We will re-institute the customer cost-share responsibility under the member’s benefit for non-COVID-19 telehealth services when the NYS executive order expires.

  • For Medicare Advantage members, we will continue to cover non-COVID-19 related telehealth services with no member cost-share through the expiration of the NYS executive order or December 31, 2020, whichever comes later.

  • Some of our self-funded groups have opted out of waiving member-cost share for non-COVID-19 services provided via telehealth. Please review our communication dated August 17, 2020 for a complete list of the self-funded groups that have opted out of waiving member cost-share. You may contact your Provider Relations representative to request a copy if you don’t have the notice on hand. For those self-funded groups that have opted out of waiving member cost-share, you may begin to apply member cost-share (i.e., copay, coinsurance, deductible) for non-COVID-19 related telehealth that were previously covered in full for some members.
  • Be sure to check eligibility and benefits using our online tool to confirm coverage and cost-sharing details for our members.
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