Members can use Teladoc^® or their provider may be able to offer them services over the phone or through a telemedicine platform where you have a real-time visual connection. Members can check availability by accessing Aetna online DocFind directory, contacting their provider or visiting the Coronavirus resource page on Aetna.com.
 

MinuteClinic offers two telemedicine options, including E-Clinic visits and MinuteClinic Video Visits. For more details, visit www.minuteclinic.com. These visits are covered by most Aetna Commercial and Medicare plans.

The use of telemedicine is encouraged as a first line of defense to limit potential COVID-19 exposure in physician offices. All member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for their Commercial plans are active until January, 31, 2021. Self-insured plans offer this waiver at their own discretion.¹ Cost share waivers for any in-network covered medical and behavioral health services telemedicine visit for Aetna Student Health plans are active until January 31, 2021.

Aetna is providing access to all Medicare Advantage members to telehealth through network providers who wish to see patients virtually. We also offer access via Teladoc^® and MinuteClinic Video Visit and E-Clinic visits. Medicare Advantage members should consider telehealth as an option to limit potential exposure to COVID-19 in physician offices.

Medicare Advantage members may use telemedicine for any reason, not just COVID-19 diagnosis. For example, they could use telemedicine to discuss their diabetes care plan or schedule a sick visit. This means members can continue to receive clinical care from their providers, without having to leave their home and risk exposure to COVID-19.²

For Individual Aetna Medicare Advantage members, copays are waived for in-network telehealth visits for primary care through the end of the Public Health Emergency. Cost share waivers for specialist telehealth visits expired on January 31, 2021 for all Medicare Advantage members. A telehealth visit with a specialist provider will now result in the same cost share as an in-person office visit.

Aetna Group Medicare retiree members should check to see their plan coverage.

Medicaid providers are encouraged to check with their state Medicaid agency for more information on regulations pertaining to telehealth guidelines.

In most cases, Aetna reimburses providers for telemedicine services, including behavioral health services, at the same rate as in-person visits. For providers with standard fee schedules, telephone-only services 99441 – 99443, when rendered between March 5, 2020 and September 30, 2020, were typically set to equal 99212 – 99214 (e.g. 99441 was set to equate to 99212). This rate change did not apply to all provider contracts (e.g. some non-standard reimbursement arrangements). After September 30, 2020, telephone-only services resumed to pre-March 5, 2020 rates.

¹Or as specified by state or federal regulation. Available in select states for select conditions. Other restrictions apply. To receive these services, you will be connected to a trusted third-party provider.

²Regulations regarding telehealth services and care package availability for Aetna Medicaid members vary by state and, in some cases, are changing in light of the current situation. Aetna Medicaid members with questions about their benefits are encouraged to call the member services phone number on the back of their ID cards.

Yes. For Commercial plans, Aetna will continue to cover limited minor acute care evaluation and care management services, as well as some behavioral health services rendered via telephone, until further notice.⁴ Please see Aetna’s telemedicine Policy for specific coverage.

^3,4Or as specified by state or federal regulation.

Aetna’s liberalized coverage of Commercial telemedicine services, as described in its telemedicine policy, will continue until further notice.⁵

All member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for Commercial plans are active until January 31, 2021.⁶ Aetna self-insured plan sponsors offer this waiver at their discretion.

Cost share waivers for any in-network covered medical and behavioral health services telemedicine visit for Aetna Student Health plans are active until January 31, 2021.

For Individual Aetna Medicare Advantage members, copays are waived for in-network telehealth visits for primary care through the end of the Public Health Emergency. Cost share waivers for specialist telehealth visits expired on January 31, 2021 for all Medicare Advantage members. A telehealth visit with a specialist provider will now result in the same cost share as an in-person office visit.

Please refer to the Telemedicine policy for services covered.

^5,6Or as specified by state or federal regulation.

For Commercial plans, the cost share waiver for any in-network covered telemedicine visit – regardless of diagnosis – began on the day of the CVS Health press release, March 6, 2020, and ended on June 4, 2020.⁷ All member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services are active until January 31, 2021. Aetna self-insured plan sponsors offer this waiver at their discretion.

Cost share waivers for any in-network covered medical and behavioral health services telemedicine visit for Aetna Student Health plans are active until January 31, 2021.

For Individual Aetna Medicare Advantage members, copays are waived for in-network telehealth visits for primary care through the end of the Public Health Emergency. Cost share waivers for specialist telehealth visits expired on January 31, 2021 for all Medicare Advantage members. A telehealth visit with a specialist provider will now result in the same cost share as an in-person office visit. Aetna Group Medicare retiree members should check to see their plan coverage.

⁷Or as specified by state or federal regulation.

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. Urgent Care Centers should continue to use POS 20. All other facilities should continue to use their respective POS; CPTs and the telemedicine modifiers must be noted on the UB-04 and HCFA 1500 forms 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. 

Aetna will cover appropriate evaluation and management codes with a wellness diagnosis for those aspects of the visit done via telehealth. Preventative visit codes should be reserved for such time when routine in-office visits resume and the remaining parts of the well visit can be completed. Both services will be fully reimbursed, and the patient will not incur a cost share.

Yes. In or out of network benefit levels will apply, depending on the provider’s network participation status.

Asynchronous telemedicine services such as email, fax, text and store and forward will not be covered unless state-mandated, included in a custom plan sponsor exception, or is a Medicare covered remote evaluation provided to our Medicare members.

Please note, for telephone only codes (98966-98968, G2010, G2012) there are reimbursement rates in the fee schedule that are not the same as E&M office visits 99201 - 99215. They are telephone only visits and do not equate to an office visit and as such will not equate to an office visit reimbursement rate.

Yes. Physicians may provide care from any location if they abide by Aetna’s telemedicine policy. Per CMS guidance, physicians should continue to bill using their currently enrolled location. Physicians should not use their home address. This applies to both commercial and Medicare claims.

Also, Aetna is now covering some telephone services for commercial members; codes for those services are in our updated telemedicine policy, available on our provider portal Availity.

Telemedicine will be covered within the capitation agreement, similar to an in-office visit.

Aetna’s telemedicine policy is available to providers on the Availity provider portal.

Behavioral Health telemedicine codes (PDF)

For Commercial plans, Aetna will cover limited minor acute care evaluation and care management services, as well as some behavioral health services rendered via telephone until further notice. For specialty, most general medicine and some behavioral health visits, a synchronous audiovisual connection is still required.

Medicare allows telephone-only telemedicine services for a limited number of codes. For other codes announced by CMS, an audiovisual connection is also still required.

Aetna’s telemedicine policy is available to providers on the Availity provider portal.

Yes. Providers can temporarily use non-public facing synchronous video chat platforms, such as Skype^® and FaceTime^®, to complete telemedicine visits as long as these platforms are allowed in their states and they are able to meet the standard of care via a telehealth encounter. Health care providers should not, however, use public-facing video applications, such as Facebook Live^®, Twitch^® or TikTok^®. For more information, refer to the Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency, concerning the use of these platforms during the COVID-19 pandemic.⁸

⁸Regulations regarding telehealth services and care package availability for Aetna Medicaid members varies by state and, in some cases, are changing in light of the current situation. Aetna Medicaid members with questions about their benefits are encouraged to call the member services phone number on the back of their ID cards.

In addition to the appropriate oral evaluation code, (for example D0140) one of the following codes should be reported:

• D9995 tele-dentistry – synchronous; real-time encounter. Reported in addition to other procedures (e.g. diagnostic) delivered to the patient on the date of service.
• D9996 tele-dentistry – asynchronous; information stored and forwarded to dentist for subsequent review. Reported in addition to other procedures (e.g. diagnostic) delivered to the patient on the date of service.

The submission of D9995 or D9996 is purely informational. These codes indicate to us that the evaluation was performed via tele-dentistry, the way a code modifier is used on a medical claim.  The code that will be reimbursed is the oral evaluation code.

Any oral evaluation covered under Aetna dental plans and performed via tele-dentistry will be reimbursed the same as if it was performed in a traditional practice setting.

We encourage providers to use technology such as FaceTime or Skype to have a “virtual visit” with a patient on an emergency basis if your practice decides to offer tele-dentistry services. Providers can inform patients of this service option when providing them emergency care instructions.

American Dental Association (ADA) COVID-19 coding and billing interim guidance (PDF)