We are providing an update on the information we currently know related to Novel Coronavirus (COVID-19) to assist you in your day-to-day business with us. Please check our website regularly for the latest news and updates – LifetimeBenefitSolutions.com.
For the most current health information, please continue to refer to the websites for the U.S. Centers for Disease Control and Prevention, the New York State Department of Health and your county health department.
If you have any questions regarding this information, please contact your Provider Relations representative. Thank you for the quality care you provide to our valued members, and for the patience and understanding you are sharing during this unprecedented time.
The American Medical Association just released a new CPT® code to streamline COVID-19 testing offered by hospitals, health systems and laboratories in the United States. The code is effective as of March 13, 2020 for use as the industry standard for reporting COVID-19 testing.
CPT Code 87635: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.
Please refer to the AMA’s CPT Assistant publication for additional information related to CPT code 87635:
At this time, the interim coding document issued by the CDC is the source for all other COVID-19 coding information:
Telehealth Visits During the COVID-19 State of Emergency
- A telehealth visit is an option for initial screenings when an in-office visit is not an option. Telehealth services are covered under all product lines.
- During the COVID-19 State of Emergency declared by Governor Cuomo, electronic information and communication technologies for telehealth include “telephonic or video modalities (including technology commonly available on smart phones and other devices) when medically appropriate to deliver health care services.”
- We will waive the cost-share for all telehealth visits (not just those related to COVID-19) for all of our members until the State of Emergency has been lifted.
- In-network telehealth visits will be covered with no member cost-share when the services would have been covered under the member’s policy if delivered in-person, including behavioral health treatment. To be covered as an office visit, the telehealth consultation must include all elements necessary for the service to be considered an office visit.
- The patient must provide consent prior to rendering telehealth services. The consent can be written or verbal and must be documented in the patient's medical record.
- Place of service code 02 is required for all telehealth services. To address concerns of virus spread/contraction during this outbreak, we will reimburse all telehealth visits billed with place of service code 02 at the same rate as in-person visits for the same CPT code, and we will use the higher non-facility (office) relative value units for dates of service from March 16, 2020 until the State of Emergency has been lifted.
- The appropriate modifier should also be used, when applicable:
- 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system
- GQ: Via asynchronous telecommunications system
- GT: Via interactive audio and video telecommunications system
- GO: New – telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke
- 25: indicates a significant, separately identifiable E&M service by the same physician, or other qualified healthcare professional on the same day as a procedure or other service
- Physical therapists: Teletherapy must meet the criteria set forth in our corporate medical policy. You can bill a non-MD phone only or non-MD video visit if you have a secure HIPAA compliant portal.