Interim telehealth provisions still in place due to COVID-19
And what this means for you
During this crisis, Magellan encourages our network providers to conduct outpatient sessions with Magellan members virtually/via computer using a HIPAA-compliant platform, whether the member’s plan typically covers telehealth or not.
Some things to keep in mind
While telehealth is available to all Magellan members during this time, you should only perform services via telehealth for which you are currently licensed.
It’s important to verify member eligibility and benefits with Magellan to ensure your license level and services will be covered.
If you bill for services you aren’t licensed to perform or which aren’t covered by the member’s benefit, those claims will deny, regardless of whether they are conducted in person or virtually.
Also, we strongly suggest that you use a HIPAA-compliant telehealth platform (real-time, interactive audio and video). However, considering the COVID-19 crisis and member access issues, you may have to utilize other (non-public) methods such as FaceTime in order to ensure the member gets the help they need (see our frequently asked questions PDF for guidance on non-HIPAA-compliant methods).
Billing telehealth sessions
- If you provide outpatient sessions using a HIPAA-compliant telehealth platform, bill the appropriate CPT code (listed on your reimbursement schedule) with the GT or 95 modifier.
- Claims submitted on an 837p or CMS-1500 form should also include place of service 02.
- Organizational providers billing professional services should bill the license-level modifier in the first modifier field and the telehealth modifier in the second modifier field.
- COVID-19: Important updates to help you care for Magellan members (including frequently asked questions)
- Telehealth has never been a better way to connect with your clients
- Virtual sessions can help reduce no shows
- Maintain your practice data for your virtual location