Anthem Policy for Telemedicine

There is confusion relating to the ability to use and be reimbursed for telemedicine as some have interpreted improperly the payment policy for Anthem related to chiropractic and other licensed providers.

For telephonic only there is exclusion of payment to these provider types but not for “telemedicine -video+audio”

This information was updated April 1, 2020 by Anthem. You will be paid for telemedicine if done appropriately with video/audio contact. Note use the proper E&M code along with modifier 95 and place of service 02. There is also a detailed one hour Telemedicine Webinar done by Sam that has much greater detail and protocol for telemedicine visits. See the main page and click on webinars.

Telehealth (video + audio):

For 90 days effective March 17, 2020, Anthem’s affiliated health plans will waive member cost shares for telehealth visits, including visits for mental health or substance use disorders, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Cost sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program.

Telephonic-only care

For 90 days effective March 19, 2020, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers. Out-of-network coverage will be provided where required. This includes covered visits for mental health or substance use disorders and medical services, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Cost shares will be waived for in-network providers only.  Exceptions include chiropractic services, physical, occupational, and speech therapies. These services require face-to-face interaction and therefore are not appropriate for telephone-only consultations. Self-insured plan sponsors may opt out of this program.