• Provider Telemedicine COVID-19 Question and Answer

  • Providers are being asked to use telephonic communication with patients who may have COVID-19 related questions and needed services.

    • Q. Are telephonic communication being covered as a Medicaid managed care benefit?
    • A. Yes, please refer to the link below on Medicaid Update March 2020, Volume 36, Number 4. In addition, Affinity’s delegated behavioral health services vendor, Beacon, has confirmed they will be following the same directive.
    • Q. Will Affinity reimburse telemedicine at the same rate as in-person office visit?
    • A. Yes, telemedicine is reimbursed based on the same established CPT codes as face-to-face appointments. Providers must append their encounters with the applicable modifier. For example, if reimbursement for CPT code 99201 is contracted at $40 for face-to-face services and CPT code 99201 is billed for telemedicine services with the applicable modifier, reimbursement will still be $40. In addition, Affinity’s delegated behavioral health services vendor, Beacon, has confirmed they will be doing the same.
    • Q. Is there a difference between how providers submit claims for telephonic services and telemedicine services? If so, what is the difference?
    • A. Telemedicine uses two-way electronic audio-visual communications to deliver clinical health care services to a patient. The provider and patient are in separate locations. The exchange of information between the provider and patient in this setting must be similar to and meet the key components and/or requirements of a face-to-face interaction. Telemedicine can be billed with CPT codes like 99201 plus the applicable modifier. Telephonic services use two-way audio communications to deliver healthcare services and are only billed with three specific CPT codes, without modifiers: 99441, 99442 and 99443.
    • Q. Are Affinity’s systems configured to eliminate all member cost sharing for telemedicine?
    • A. Yes. Please refer to the link below on additional information about telemedicine: https://www.health.ny.gov/health_care/medicaid/program/update/2020/index.htm