Guidance on coverage and billing during COVID-19

Avera Health Plans has been fielding questions around the coverage of telehealth services during the current COVID-19 pandemic. We're providing flexibility to providers during this difficult time in regards to telehealth guidelines based off CMS guidelines.

Providers:

  • Will be expected to follow normal CPT coding and billing guidelines;
  • Should document the means by which the telehealth service was provided and billed; and
  • May append telehealth services using HIPPA compliant, real-time audio-video technology with modifier 95, although it will not be required.

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Medical codes for telehealth visits

We have established the following list of codes that are approved for telehealth.

The top portion of the list represents the normal listing of codes we include in our Telehealth Reimbursement Policy. The codes listed afterwards represent our position on telehealth expansion during the COVID-19 National Public Health Emergency and include the codes released by CMS in their March 30th announcement as well as some others we have added of our own based on provider feedback.

These telehealth expansion codes will be permitted during the period of March 17 through June 30. The expansion period will be evaluated in early June for potential extension and the code list may be subject to additional updates.

We will post any additions or revisions on the website if they occur so check the list frequently for updates.

Our team is here to help

Our Provider Relations staff are available to help answer further questions related to this announcement. If you have questions and want to reach out, please see our team territory map and contact information below.

For more information around COVID-19 benefits and coverage for members/patients, visit our COVID-19 Health Insurance Information page.

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