Answer:
A code for 5-10 minutes
A code for 11-20 minutes
A code for 21-30 minutes
If a provider or therapist sees someone for 45 or 55 minutes would they be able to use the code for 21-30 minutes and then “stack” another code to get to the 45 or 55 minutes? OR Would we just be reimbursed for 30 minutes even though the service and the documentation was for 45 or 55 minutes?
Answer: Thanks for clarifying. Yes, the new telephonic and management codes 98966 (5-10 min), 98967 (11-20 min) and 98968 (21-30 min) may be stacked. however these codes are not used to provide therapy. Psychotherapy codes should be billed per usual times.
Reminder: COVID-19 Questions
Many providers have been asking us their COVID-19-related questions. Please keep the questions coming! You can use our COVID-19 Question Submission Form any time to submit yours. We will review and respond to all questions in a Question and Answer document.
General Questions and Feedback
For questions related to this memo, please contact your agency-assigned Provider Relations Account Representative (PRAR). If you do not know the PRAR assigned to your agency, please contact Network Operations at (888) 977-2160 or networkoperations@eastpointe.net.
As always, thank you to all our providers who continue to work diligently during this crisis to deliver the best possible care for our members. We appreciate all of your valiant efforts.
10. Question: Will there be rate increases for PRTF’s to help cover the extra cost to provide services during the COVID-19 crisis?
Answer: Yes, please see the COVID-19 Provider Update #10 COVID Reimbursement document.
Answer: Please reference the COVID-19 Provider Update #10 COVID Reimbursement to review our updated Service Authorization Request policy.
21. Question: Any update as to how Eastpointe wants us to provide group services like PSR and SAIOP while practicing social distancing? Are they looking at allowing us to prove an alternative service with our PSR members?
Answer: Initial guidance has been provided in DHHS Special Bulletin #20. Eastpointe is continuing to review Substance Services and more information is forthcoming.
Can you clarify when a non-clinical person, ie Qualified Professional, can use any of the codes listed?
Answer: Therapy provided via telehealth modalities has been extended to include Licensed Associates in addition to LCMHC, LP, LCSW, LMFT, LCAS and a Physician (Special Bulletin #19). There has been no indication of staff in addition to these being able to provide the services.
Thank you to all of our providers who continue to work diligently during this crisis to deliver the best possible care for our members. We appreciate all of your valiant efforts.
CPT codes sent to us:
98966
98967
98968
Our regular CPT codes:
90791
90834
90837
90846
90847
Answer: CR should only be added to the new codes published for telephonic sessions. These codes and descriptions can be found at the following link:
Special Bulleting COVID 19 #9 Telehealth Provisions – Clinical Policy Modification. Previously used telemedicine and telepsychiatry codes listed in Clinical Coverage Policy 1H should still be used with the GT modifier.
Unfortunately, at this time, the Division has not provided clarity on Day Treatment. We are working internally to strategize on solutions and will have an update soon.
At this time, we do not have access to PPE however we are aggressively pursuing options/resources.
Answer: The telephonic codes can be billed to Eastpointe at this time.
As always, thank you to all of our providers who continue to work diligently during this crisis to deliver the best possible care for our members. We appreciate all of your valiant efforts.
Providers can bill for allowed services as described in this Medicaid Bulletin beginning March 23, 2020, for dates of service on or after March 10, 2020. NC Medicaid will continue to release telehealth policy provisions and will continue to evaluate this policy throughout the state of emergency period.
There are three telehealth modalities referenced within this policy bulletin, defined as:
Here is some additional detail on the provision of telemedicine and telepsychiatry services:
Coverage and Payment Parity: Consistent with its existing policy, telemedicine and telepsychiatry have coverage and payment parity with in-person care. Medicaid and NC Health Choice will continue to cover and reimburse all telemedicine interactions at a rate that is equal to in-person care as long as they meet the standard of care and are conducted over a secure HIPAA-compliant technology with live audio and video capabilities.
The following are policy modifications related to telemedicine and telepsychiatry:
“Eastpointe will accept a qualified professional/para-professional or clinician signature in place of the member or legally responsible person’s (LRP) signature, along with a notation that the member/LRP gave consent for the provider representative to sign the document on his or her behalf.”
Are staff to put their own names in the place of the patient’s name, on the patient’s line, and then indicate how consent was given? Or are staff writing the patient’s name on the patient’s line, and then indicating that they had consent to write it? Any clarification would be appreciated. Thanks.
Answer: Staff should put their own names in place of the patient’s name, along with the notation that the patient/LPR gave consent for the provider representative to sign the document on his or her behalf. The provider should document whether the consent was made via telephone, email or other means.
As always, thank you to all of our providers who continue to work diligently during this crisis to deliver the best possible care for our members. We appreciate all of your valiant efforts.
If you need technical assistance with the application process with CAQH their Help Desk number is 1-888-600-9802.
Please also refer to the link below; Special Medicaid Bulletin posted Friday regarding telehealth modifications to Clinical Policy 1H. Special Bulleting COVID-19 #9 Telehealth Provisions Clinical Policy Modification
Special Bulleting COVID 19 #9 Telehealth Provisions – Clinical Policy Modification. Previously used telemedicine and telepsychiatry codes listed in Clinical Coverage Policy 1H should still be used with the GT modifier.
“Always try and obtain express consent for disclosure of any substance use information. Member/LRP consent or approval should be clearly documented in the service note.”
Does the QP/Para/clinician signature apply to patient written consents for releasing information or records and not only to care plans? In other words, provider agency staff completes (with patient’s cooperation) consent form for patient so agency can release certain records to a certain party or individual for certain purposes, and patient provides verbal consent over the phone. The agency employee obtaining patient’s consent documents on the consent form that it was given over the phone. Of course, this will apply not only to substance use information but also to mental health information. I would appreciate your response. Thank you.
Answer: Yes, this may also be used for a consent to release information.
The provider should document whether such consent was made via telephone, email or other means (e.g. through a window). Any provider relying upon email consent should follow up via telephone communication with the member/LRP to secure verbal consent if possible.
To verify you are speaking with the member/LRP, best practice is to ask for another identifier (besides name and date of birth), such as a Social Security number or Medicaid number. Always try and obtain express consent for disclosure of any substance use information. Member/LRP consent or approval should be clearly documented in the service note.
As always, thank you to all of our providers who continue to work diligently during this crisis to deliver the best possible care for our members. We appreciate all of your valiant efforts.