Guidance for Providers Treating MVP Health Care Members
Telemedicine
MVP is covering all telemedicine services at no cost-share to the Member during the declared State of Emergency.
Providers should submit claims for Covered Services as outlined below in order for the Member cost-share to be waived:
- Submit the appropriate Evaluation & Management (E/M) or CPT code (for example 99212 or 99213)
- Submit the claim with the appropriate place of services (POS) code that would have been reported had the services been furnished in person.
- Claim modifiers “95” or “GT” should be appended as appropriate on each claim that represents a service delivered via Telemedicine.
- 95 modifier – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunication system.
- GT modifier – Via interactive audio and video telecommunication systems.
Providers do not have to have an existing patient relationship with a Member to be reimbursed for telephone triage services and health care services delivered through telemedicine or audio-only telephone.
While we encourage Providers to bill consistent with an office visit – and understand that certain services can be time consuming and complex even when provided virtually – such services should be coded at a level of care appropriate for provision through a telephonic mechanism and Providers should maintain documentation in the medical record for the level of care billed.
Telemedicine visits will be included in any applicable Member benefit visit limitations.
Telemedicine Platforms
The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telemedicine during the COVID-19 State of Emergency. Providers who want to use audio or video communication technology to provide telemedicine during the State of Emergency can use any non-public facing remote communication product that is available to communicate with patients.
- Examples of Acceptable Platforms (non-public facing): Apple FaceTime, Google G Suite Hangouts Meet, Skype for Business
- Examples of Unacceptable Platforms (public facing): Facebook Live, Twitch, TikTok
Store and Forward
In Vermont, MVP is covering Store and Forward technology when the below code, or any other appropriate procedure code, is billed, along with modifier GQ:
| CPT Code | Description |
| G2010 | Remote evaluation of recorded video and/or images submitted by the patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. |
Telephone Visits
New York Commercial Members
Virtual Check-In
Providers should bill the following G codes for all Commercial Members when conducting visits via telephone. These will be covered at no cost-share* to Members during the declared State of Emergency.
| CPT Code | Description |
| G2012 | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management [E/M] services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| G2010 | Remote evaluation of recorded video and/or images submitted by the patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. |
The codes below may also be used for telephonic visits with Commercial Members. These will be covered at no cost-share* to the Member during the declared State of Emergency.
| CPT Code | Description |
| 99441 | Telephone evaluation and management service; 5-10 minutes of medical discussion |
| 99442 | Telephone evaluation and management service; 11-20 minutes of medical discussion |
| 99443 | Telephone evaluation and management service; 21-30 minutes of medical discussion |
Self-funded Members should consult directly with their employer to see if their employer is waiving cost-share for telemedicine or telephone visits.
New York Medicaid Members
The codes below should be used for telephonic visits with Medicaid Members. These will be covered at no cost-share to the Member during the declared State of Emergency.
| CPT Code | Description |
| 99441 | Telephone evaluation and management service; 5-10 minutes of medical discussion |
| 99442 | Telephone evaluation and management service; 11-20 minutes of medical discussion |
| 99443 | Telephone evaluation and management service; 21-30 minutes of medical discussion |
Vermont Commercial Members
As of March 13, 2020, MVP is covering telephone-only codes as a telemedicine visit at no cost-share to Members in Vermont. Providers will be reimbursed same as in person visits, rates based on their Provider Agreement.
Providers should submit claims for telephone only visits as telemedicine visits for Covered Services as outlined below in order for the Member cost-share to be waived:
- Submit the appropriate Evaluation & Management (E/M) or CPT code (for example 99212 or 99213)
- Submit the claim with the POS code that would have been reported had the services been furnished in person
- Claim modifiers “95” or “GT” should be appended as appropriate on each claim that represents a service delivered via Telemedicine.
- 95 modifier – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunication system.
- GT modifier – Via interactive audio and video telecommunication systems.
Providers do not have to have an existing patient relationship with a Member to be reimbursed for telephone triage services and health care services delivered through telemedicine or audio-only telephone.
While we encourage Providers to bill consistent with an office visit – and understand that certain services can be time consuming and complex even when provided virtually – such services should be coded at a level of care appropriate for provision through a telephonic mechanism and Providers should maintain documentation in the medical record for the level of care billed.
In addition, MVP will also cover the following telephonic codes. These will be covered at no cost-share to the Member during the declared State of Emergency.
| CPT Code | Description |
| 99441 | Telephone evaluation and management service; 5-10 minutes of medical discussion |
| 99442 | Telephone evaluation and management service; 11-20 minutes of medical discussion |
| 99443 | Telephone evaluation and management service; 21-30 minutes of medical discussion |
TeleMental Health
Effective March 13, 2020, during the duration of the State of Emergency, Behavioral Health Providers, including qualified practitioners and services Providers, may deliver Covered Services via TeleMental Health, including telephonic services at no cost-share to the Member.
Providers should submit the appropriate E/M or CPT code along with the POS code that would have been reported had the services been furnished in person and use claim modifiers “95” or “GT” on each claim that represents a service delivered via TeleMental Health.
- 95 modifier – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunication system
- GT modifier – Via interactive audio and video telecommunication systems
Providers in OMH/OASAS Licensed Facilities or Designated Programs should work with the NYS Office of Mental Health (OMH) to ensure the required attestation is on file with OMH. Access the Self-Attestation of Compliance to Offer TeleMental Health Services form .
Behavioral Health Providers may bill for Applied Behavioral Analysis (ABA) Covered Services which would otherwise be covered in a Commercial Member’s Subscriber Contract for in-person visits as a TeleMental Health visit at no cost-share to the Member.