00.06.02ae Preventive Care Services (AmeriHealth)
Telemedicine and Telehealth Services for AmeriHealth New Jersey Members (Updated May 19, 2020)
The purpose of this News Article is to provide advance notice regarding coverage for preventive well visits through telemedicine for our
AmeriHealth New Jersey members in response to Coronavirus Disease 2019 (COVID-19).
This communication addressing well visits via telemedicine services is effective from March 6, 2020 through the later of either June 30, 2021 or for a period of 90 days following the end of the State of Emergency and Public Health Emergency as described in Executive Order 103.
There is currently an outbreak of respiratory disease caused by a novel coronavirus, which has now been detected internationally. The virus has been named “SARS-CoV-2” and the disease it causes has been named “Coronavirus Disease 2019” (COVID-19). The SARS-CoV-2 virus has demonstrated the capability to rapidly spread, leading to significant impacts on healthcare systems and causing societal disruption. The potential public health threat posed by COVID-19 is high globally. To effectively respond to the COVID-19 outbreak, rapid detection of cases and contacts, appropriate clinical management and infection control, and implementation of community mitigation efforts are critical.
To help reduce potential exposure, members and participating providers may utilize telemedicine services to perform components of a preventive well visit as detailed below and available as part of a member’s plan.
Preventive well visits performed through telemedicine are considered eligible for reimbursement consideration when both of the following criteria are met:
- The well visit is performed through interactive, synchronous (real-time) two-way audio and video communications, and includes all components that can be performed through telemedicine (e.g., history, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures); AND
- The well visit will include a subsequent office-based visit for the completion of the physical examination component of the preventive well visit. The subsequent office-based visit is not eligible for separate reimbursement consideration. Reimbursement for the subsequent office-based visit is included in the telemedicine preventive well visit.
The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.
The Company may conduct reviews and audits of services to our members, regardless of the participation status of the professional provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Eligible professional providers performing components of the preventive well visits, as appropriate, through interactive, synchronous (real-time) two-way audio and video communications must report the appropriate procedure code, appropriate modifier (GT or 95), and place-of-service (POS) code 02 (Telehealth), to ensure payment of eligible telemedicine services.
Inclusion of a code in this News Article does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.
Dosing and Administration
Black Box Warnings and/or Contraindications
PREVENTIVE WELL VISIT
99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, G0438, G0439
SUBSEQUENT OFFICE-BASED VISIT
- Eligible professional providers performing the subsequent office-based visit for the completion of the physical examination component must report procedure code 99429 (Unlisted preventive medicine service) along with a narrative that indicates the service is for completion of the well visit and listing the date of the initial telemedicine visit. For example, "Completion of well visit from XX/XX/2020".