I just got off of the phone with Aetna’s Senior Medical Director for Southeast U.S.
Good news! He says Aetna is covering telehealth well checks! However, the way they want it is a bit different than other payors.
The first portion of the well check which is done by telehealth should be billed as an telehealth OFFICE VISIT (99212-99215) with -95 modifer and place of service -02.
The second portion of the well check which must include the PHYSICAL EXAM should be billed with the normal well check codes (99391-99385, 99391-99395). No special modifiers for that visit.
This is the opposite of what several other payors want, but the good news, is that as long as all the kids actually return to your office then you are being paid for all the work that you have done!
Their systems are already set up to process this, so it is effective immediately. He is going to work on getting official Aetna policy out to make this clear to everyone.
Hi Sandy! Do you know if Aetna plans to release this information to the public?
They are working on their policy as we speak! Also, I’ve heard from some that Aetna prefers place of service 11 (office) for their telehealth visits. So, 95 modifer and POS 11 with a 99212-99215. This would be what we would use for sick visits and for the first part of the well check that is done by telehealth. They have also waived all copays on telehealth. The only thing I don’t yet have clear is what the dx code should be for the telehealth portion of the well check. Will a well check dx code go through? Hopefully this will be clear in their policy.
What CPT code should we use with the first Visit?
When copays are waived with telehealth, does this mean No One pays the copay or does the insurance company pay it?
Hey Sandy! If you check Aetna’s Provider FAQs for Telehealth, they address the place of service. I’m seeing that they still want to see POS 2:
"What place of service code should be used for telemedicine services?
For commercial members non-facility telemedicine claims must use POS 02 with the GT or 95 modifier. Fee schedules have been updated so claims with approved telemedicine CPT codes and modifiers with POS 02 will be reimbursed at the same rate as an equal office visit. For example, a telemedicine service 99213 GT with POS 02 will reimburse the same as a face-to-face in-office visit 99213. Facilities should continue to use their respective POS; CPTs and the telemedicine modifiers must be noted on the UB-04 form as the Rev Code will not be sufficient.
For Medicare members, POS 02 or POS 11, or the POS equal to what it would have been had the service been furnished in-person, along with the 95 modifier indicating that the service rendered was actually performed via telehealth, may be utilized and will reimburse at the same rate."
I wish they’d make up their mind. They had been saying use POS 11 to get true parity payment, now they’ve flip-flopped again. I have to think their methods are intentional. I just appealed a claim from 3/27, which used the POS 02, because they only paid 70% of my allowable.
The insurance company is supposed to pay it. I have verified that with all of our major payors in Virginia and our Medicaid. CareFirst messed it up for several weeks and they are reprocessing the claims and fixing that.
Yes. We had that happen to. We use POS 02 because their policy said to do it. Then they paid lower than contracted rate (we have had parity in Virginia for telehealth for years). We were told to refile using POS 11 with a 95 modifier and now they are paying correctly.
Our Aetna rep told us to refile with -95 and POS 11. When we did -95 and POS 02, they paid us too low. Now with -95 modifier and POS 11, they are paying parity for telehealth (like they are supposed to). They should fix their policy online if this is what we are supposed to do!
Unrelated specifically to wells. We have seen that we get paid faster with POS 11 instead of 02.
Sandy, Aetna still hasn’t added well visits to their list of allowed telemedicine codes, and our local representative says she hasn’t heard of this change to their telemedicine policy. Do you have anything in writing showing we can bill Aetna for well checks performed virtually?
I reached out to the Aetna Director who told me the policy that I posted and he said they are still working on updating the website FAQs. Hopefully they will do it soon so that we can all have clarity on this.
Same here. Significant difference.