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Regence to Expand Telemedicine Coverage


  • Given the extraordinary challenges our medical community is facing, we are expanding the ability for our providers to provide telemedicine services when appropriate for their patients at the same reimbursement as if in the office.  

    This temporary expansion is for both medical and behavioral health telehealth services to our Individual, group (including administrative services only groups who have the telehealth benefit), and Medicare members. This expansion will remain in effect through each state’s emergency declaration. 

     Details are on our provider webpage and highlighted below:

    Telehealth expansion:

    •We are expanding the services that can be offered by in-network providers via telehealth. 

    •The visits are considered the same as in-person visits and are paid consistently with in-person visits. 

    •The member’s coinsurance and deductible will apply to these services. 

    •We are following the U.S. Department of Health and Human Services’ (HHS’) lead on discretion with respect to HIPAA compliant platform requirements. 

    The services must: 

    ◦Be safely and effectively delivered via telehealth 

    ◦Meet the code definition that is billed when provided via telehealth 

    ◦Meet existing coverage criteria, including pre-authorization requirements and medical necessity 

      •Under this expansion for claims to process correctly, claims must be submitted with POS 11 or IOP and the GT modifier. (Note: To receive reimbursement consistent with an in-office visit, the POS must be either 11 or IOP. The GT modifier will indicate that the services were rendered via telehealth.) 

      •Claims can be submitted on or after Tuesday, March 24, 2020, for dates of service beginning on March 19, 2020. 

    Additionally, we will continue to cover the medical and behavioral health codes, as outlined in our Virtual Care (Administrative #132) reimbursement policy. Claims submitted following the guidelines in this policy will be paid as they have been.

    Thank you all for the amazing work you do every day.

    Drew Oliveira, MD, MHA
    Senior Executive Medical Director, Regence Blue Shield