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. Through December 31, 2020, Aetna has extended all member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for their Commercial plans. Self-insured plans offer this waiver at their own discretion.¹ Cost share waivers for any in-network covered medical or behavioral health services telemedicine visit for Aetna Student Health plans are extended until December 31, 2020.

Through December 31, 2020, Aetna is waiving cost shares for all Medicare Advantage plan members for in-network primary care and specialist telehealth visits, including outpatient behavioral and mental health counseling services. Aetna Medicare Advantage members should continue to use telemedicine as their first line of defense for appropriate symptoms or conditions to limit potential exposure in physician offices. Cost sharing will be waived for all Teladoc^® general medical care virtual visits. Cost sharing will also be waived for covered real-time virtual visits offered by in-network providers (live videoconferencing or telephone-only telemedicine services). Medicare Advantage members may use telemedicine for any reason, not just COVID-19 diagnosis.²
 

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.

²Disclaimer: Regulations 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.

Through December 31, 2020, Aetna has extended all member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for their Commercial plans.⁷ Self-insured plans offer this waiver at their own discretion.⁸ Cost share waivers for any in-network covered medical or behavioral health services telemedicine visit for Aetna Student Health plans are extended until December 31, 2020.

Through December 31, 2020, Aetna is waiving cost shares for all Medicare Advantage plan members for in-network primary care and specialist telehealth visits, including outpatient behavioral and mental health counseling services. Aetna Medicare Advantage members should continue to use telemedicine as their first line of defense for appropriate symptoms or conditions to limit potential exposure in physician offices. Cost sharing will be waived for all Teladoc® virtual visits. Cost sharing will also be waived for covered real-time virtual visits offered by in-network providers (live videoconferencing or telephone-only telemedicine services). Medicare Advantage members may use telemedicine for any reason, not just COVID-19 diagnosis.⁹

For Medicare Advantage plans, effective May 13, 2020 through December 31, 2020, Aetna is waiving member out-of-pocket costs for all in-network primary care visits, whether done in-office and via telehealth, for any reason, and encourages members to continue seeking essential preventive and primary care during the crisis. 

⁷Or 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.

⁸Disclaimer: Regulations 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.

⁹Disclaimer: Regulations 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.

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. 

Yes, the no-cost benefit applies to telemedicine visits for behavioral health.¹¹

¹¹ Disclaimer: Regulations 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.

No, this no-cost benefit only applies to real-time virtual care delivered by an in-network provider. Non-participating provider coverage is based on the member’s benefit/plan design for out-of-network benefits.¹²

¹²Disclaimer: Regulations 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.

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.
 

Telephone only services 99441 – 99443 are now set to equal 99212 – 99214 (e.g. 99441 is set to equate to 99212). This change will remain in effect until further notice.
 

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.  

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 portal.

Approved behavioral health telemedicine services

Behavior Health codes are assessable on Aetna’s website.

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 December 31, 2020. 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 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 temporary Federal guidelines concerning use of these platforms during the COVID-19 pandemic.¹³

¹³ Disclaimer: Regulations 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. 

Additional guidance from the American Dental Association (ADA) can be found on their website.