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1. Tricare Telemedicine Copay
2. Humana Telemedicine Copay
3. Tricare Telemedicine Copay
4. Copays For Telemedicine
5. Telemedicine Copays Waived

1. Co-payments are not required for covered services delivered via telemedicine or telehealth to CHIP members. Provider Reimbursement The member’s MCO will reimburse the provider the full rate for the service, including what would have been paid by the member through cost-sharing.
2. During the COVID-19 public health emergency, the new waiver in Section 1135(b), opens in new window of the Social Security Act (found on the CMS Telemedicine Fact Sheet) authorizes use of telephones that have audio and video capabilities to provide Medicare telehealth services. Additionally, the Health & Human Services Office for Civil Rights (HHS OCR) will exercise enforcement discretion.

You’ll have a $0 copay. for specialist telehealth visits, including mental health counseling, until January 31, 2021. We will waive costs for mental health visits through: In-network providers who deliver virtual care, such as over-the-phone care and live video conferencing.

CareFirst is encouraging members to call their doctor’s office if they have symptoms of the flu, COVID-19 or other contagious conditions. During this public health event, we understand the use of telemedicine is a practical option for members who wish to or should stay home. Therefore, we have temporarily expanded our telemedicine policy. Refer to our coding guidance for all existing and temporarily covered services.

Telemedicine Capability

If your practice has its own telemedicine capability (audio/video), proceed with visits and bill CareFirst as normal with a place of service “02” and refer to this guidance for accepted telemedicine procedure codes and modifiers. Services for diagnosis, consultation or treatment provided through telemedicine must meet all the requirements of a face-to-face consultation or contact between a licensed health care provider and a patient consistent with the provider's scope of practice for services appropriately provided through telemedicine services.

If the claim is to evaluate a member for coronavirus, use diagnosis code Z20.828 (Exposure to viral disease). If you are treating a member with confirmed coronavirus use diagnosis code B97.29 for dates of service prior to 4/1/20 and diagnosis code U07.1 for dates of service on and after 4/1/20. Utilization review may be performed. Documentation in the medical record must support the services rendered.

Tricare Telemedicine Copay

Humana Telemedicine Copay

If you are currently not set up to conduct telemedicine, you can use a commercially available platform to conduct telemedicine visits. The Office for Civil Rights (OCR) at the HHS has stated that providers may use commercially available video chat services to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules during the COVID-19 nationwide public health emergency. Guidance and frequently asked questions can be found on their website.

Please note, CareFirst is waiving cost sharing for in-network or out-of-network visits to a provider’s office, including telemedicine, related to diagnosis and treatment of COVID-19. Providers are encouraged not to collect member cost sharing for these services. If a member does owe a copay or coinsurance after the claim is processed, you can bill the member as you do for all other claims. For these purposes we’ve defined telemedicine as a combination of interactive audio and video.

Member-Initiated Phone Consultations

Tricare Telemedicine Copay

CareFirst is paying for phone consultations provided by physicians and nurse practitioners credentialed in CareFirst’s network for the following specialties: primary care provider, internal medicine, OB/GYN, family practice and pediatrics. CareFirst will pay a $20 flat fee for CPT 99441.* We selected this code for all phone visits, regardless of the amount of time.

* These benefits are covered for our fully insured members. We are also partnering closely with our self-insured customers to implement similar measures. Due to a change in D.C. law for members covered by a D.C. insured product, member-initiated phone calls are covered at $20, regardless of a provider’s specialty. Physicians and Nurse Practitioners should use CPT Codes 99441, 99442 or 99443. Non-physician providers should use CPT codes 98966, 98967 or 98968.

Copays For Telemedicine

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Telemedicine Copays Waived

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