Question Phone visit billing in PEDS, Covid 19

ljhaley@gmail.com

Networker
Messages
66
Best answers
0
Hi Everyone,
We are a small Peds practice that does NOT have Video abilities at this time so ALL of our soon to be "telephone" visits due to COVID situation will be audio only.
We understand the rules regarding who/how/when we can use these codes from these awesome forums and the CPT book. What we don't have information on is this:
We don't bill ANY Medicare, because we are Peds. MOST of our commercial payers, when these codes originally became available, said they are non payable PERIOD. Now our local NYS BCBS has said due to the COVID they will temporarily consider these codes for reimbursement. (YAY) However, they hinted calls for non physician audio only CPT 98966-98968 would be considered for COVID related issues, (We read between the lines just covid calls??) Does anyone out there have any experience yet billing commercial payers successfully for CPT 98966-98968? ANY guidance would be appreciated, modifier info too. Grateful thanks! :)
 
Messages
4
Location
Carson City, NV
Best answers
0
Hi Everyone,
We are a small Peds practice that does NOT have Video abilities at this time so ALL of our soon to be "telephone" visits due to COVID situation will be audio only.
We understand the rules regarding who/how/when we can use these codes from these awesome forums and the CPT book. What we don't have information on is this:
We don't bill ANY Medicare, because we are Peds. MOST of our commercial payers, when these codes originally became available, said they are non payable PERIOD. Now our local NYS BCBS has said due to the COVID they will temporarily consider these codes for reimbursement. (YAY) However, they hinted calls for non physician audio only CPT 98966-98968 would be considered for COVID related issues, (We read between the lines just covid calls??) Does anyone out there have any experience yet billing commercial payers successfully for CPT 98966-98968? ANY guidance would be appreciated, modifier info too. Grateful thanks! :)
I am also in Peds. The loosened regulations are great ! We also do not take Medicare. I am following to see if any other Peds have information.
 
Messages
322
Best answers
0
Hi Everyone,
We are a small Peds practice that does NOT have Video abilities at this time so ALL of our soon to be "telephone" visits due to COVID situation will be audio only.
We understand the rules regarding who/how/when we can use these codes from these awesome forums and the CPT book. What we don't have information on is this:
We don't bill ANY Medicare, because we are Peds. MOST of our commercial payers, when these codes originally became available, said they are non payable PERIOD. Now our local NYS BCBS has said due to the COVID they will temporarily consider these codes for reimbursement. (YAY) However, they hinted calls for non physician audio only CPT 98966-98968 would be considered for COVID related issues, (We read between the lines just covid calls??) Does anyone out there have any experience yet billing commercial payers successfully for CPT 98966-98968? ANY guidance would be appreciated, modifier info too. Grateful thanks! :)
I don't know payer guidelines and those will be specific to individual health plans but look for wording such as " as well as minimizes unnecessary exposure to individuals needing medical care for other conditions." Also, it is important to recognize that codes 98966-98968 apply only to services by providers who cannot bill E/M codes. All physicians and advanced practice professionals like NPs and PAs should report 99441-99443. Cindy
 
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