This version of the policy will become effective 07/01/2021. The policy criteria were updated to address eligible services and provider specialties.
The following codes were removed from the policy and are not eligible for coverage through telemedicine: 77427, 90849, 90853, 90875, 90953, 90956, 90959, 90962, 92002, 92004, 92012, 92014, 92601, 92602, 92603, 92604, 94002, 94003, 94004, 94664, 96112, 96113, 96116, 96121, 96125, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96164, 96165, 97153, 97154, 97158, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99224, 99225, 99226, 99234, 99235, 99236, 99238, 99239, 99291, 99292, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99468, 99469, 99471, 99472, 99473, 99475, 99476, 99477, 99478, 99479, 99480, 0362T, 0373T, G0420, G0421, G0438, G0439, G9685, 93797, 93798, S9472, G0424, S9473, H0015, S9480, H0035, S0201, 97129, 97130, 97163, 97166, 97167, 97530, 97533, 97535, 97542, 97750, 97755, 97760, 97761,
97129, 97130, G0153, G0161, S9128, S9152, S9083
The following revenue codes were removed from the policy and are not eligible for coverage through telemedicine: 0561, 0562, 0551, 0420, 0421, 0422, 0424, 0431, 0432, 0434, 0441, 0442, 0444, 0590, 0905, 0906, 0912, 0913, 0655, 0656, 0943, 0948, 0780
The following codes were added to the policy as eligible through telemedicine:
92227, 96040, 99408, 99409, S0265
The following CPT codes have been removed from the policy: 99251, 99252, 99253, 99254, 99255
The position of the following codes was changed from eligible to not eligible for reimbursement: G0071, G0508, G0509, G2010, G2012, G2061, G2062, G2063
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Note: The policy in notification was updated 04/02/2021 to include the following changes:
The modes of communication policy criteria in the medical services section was updated to address asynchronous telecommunications in conjunction with a synchronous audio communication would be considered eligible for reimbursement. Additional not eligible for reimbursment criteria was added to the policy.
The following codes were removed from the policy and are not eligible for coverage through telemedicine: 92507, 92508
The position of the following code was changed from eligible to not eligible for reimbursement: G2025
Modifier GQ position was changed from covered to not covered.
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Note: The policy in notification was updated July 1, 2021 to include the following changes.
The following behavioral health codes were added to be eligible for coverage through telemedicine:
90849, 90853, 90875, 96116, 96121, 96125, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96164, 96165, 97153, 97154, 97158, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99234, 99235, 99236, 99238, 99239, 99324, 99325, 99326, 99327, 99328, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, H0015, H0035, S0201, S9480,