Until June 4, 2020, Aetna will waive member cost sharing for any in-network covered telemedicine visit – regardless of diagnosis – for their Commerical plans.1 For Aetna Commercial plans offering Teladoc® , MinuteClinic Video Visit coverage or a different virtual care option2, cost sharing will be waived for those virtual visits. Cost sharing will also be waived for covered real-time virtual visits offered by in-network providers (live videoconferencing and telephone-only telemedicine services) for all Commercial plan designs. Commercial members may use telemedicine services for any reason, not just COVID-19 diagnosis. Self-insured plan sponsors offer this waiver at their discretion.3
Through September 30, 2020, Aetna is extending all member cost-sharing waivers for covered in-network telemedicine visits for outpatient and mental health counseling services for their Commercial plans.4 Self-insured plans offer this waiver at their own discretion.5
Through September 30, 2020, Aetna is extending all member cost-sharing waivers for in-network telehealth visits for outpatient behavioral and mental health counseling services for all Medicare Advantage plan members. 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 real-time virtual visits offered by in-network providers (live video conferencing or telephone-only telemedicine services). Medicare Advantage members may use telemedicine for any reason, not just COVID-19 diagnosis.6
For Medicare Advantage plans, effective May 13, 2020 through September 30, 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 member to continue seeking essential preventive and primary care during the crisis.
Aetna and self-insured plan sponsors, as appropriate, will continue to cover member cost sharing for services included in the Families First Coronavirus Response Act (such as COVID-19 testing and visits resulting in a COVID-19 test).
1Available in select states for select conditions. Other restrictions apply. To receive these services, you will be connected to a trusted third-party provider.
2Please refer to your specific plan design, or call the number on the back of your ID card, to confirm benefits if you are a member of one of the following: Banner|Aetna, Sutter Health | Aetna, Texas Health Aetna, Innovation Health, Allina Health | Aetna
3Disclaimer: 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.
4Available in select states for select conditions. Other restrictions apply. To receive these services, you will be connected to a trusted third-party provider.
5Disclaimer: 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.
6Disclaimer: 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.
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. Commercial member telemedicine visits are covered with no cost-sharing to the member, until June 4, 2020. Through September 30, 2020, Aetna is extending 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. For Medicare members, primary care and behavioral health telemedicine visits are covered with no cost-sharing to the member, through September 30, 2020. Aetna reimburses all providers for telemedicine at the same rate as in-person visits.
Medicaid providers are encouraged to check with their state Medicaid agency for more information on regulations pertaining to telehealth guidelines.
Please note, for telephone only codes (99441-99443, 98966-98968, G2010, G2012) there are reimbursement rates in the fee schedule that are not the same as E&M office visits 99201- 99215. Given those telephone only codes do not equate to an office visit, they will not result in an office visit reimbursement rate.
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 August 4, 2020. The member cost share waivers for medical care for Commercial plans will end on June 4, 2020. Please see Aetna’s telemedicine Policy for specific coverage.
Aetna’s liberalized coverage of Commercial telemedicine services, as described in its telemedicine policy, will now extend through August 4, 2020. Cost share waivers for covered telemedicine services will expire on June 4, 2020, except for Behavioral Health services, which will continue at no cost to members until September 30, 2020.
Medicare Advantage will continue to waive cost shares for virtual Primary Care and Behavioral Health services through September 30, 2020.
Please refer to the Telemedicine Policy for services covered.
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. Facilities should continue to use their respective POS; CPTs and the telemedicine modifiers must be noted on the UB-04 form 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.
No, members with a telemedicine benefit can take advantage of this no-cost telemedicine benefit for any reason, include general medical, behavioral health and dermatology visits.5
5Disclaimer: 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.
6Disclaimer: 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.
Yes, the no-cost benefit applies to telemedicine visits for behavioral health.6
6Disclaimer: 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.7
7Disclaimer: 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.
Please note, for telephone only codes (99441-99443, 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.
For telephone only codes (99441-99443, 98966-98968, G2010, G2012) there are reimbursement rates in Aetna’s fee schedule that are not the same as E&M office visits 99201- 99215. Given those telephone only codes do not equate to an office visit, they will not result in an office visit reimbursement rate.
Behavior Health codes are assessable on Aetna’s website.
For Commercial plans, until August 4, 2020, Aetna will cover limited minor acute care evaluation and care management services, as well as some behavioral health services rendered via telephone. For 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 telemedicine policy is available to providers on the NaviNet and Availity portals.
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.8
8 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:
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.
Looking for a referral to help one of your patients during this time? We are updating our online provider directory with providers who are offering telemedicine services.
You may also refer your patients to Teladoc®. Teladoc offers convenient and quality alternative care to Emergency Room and Urgent Care visits for non-emergency medical care. Care is available 24/7/365 by web, phone and the Teladoc mobile app.*
*Please have your patients confirm that their plan includes Teladoc.
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This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.
Health benefits and health insurance plans contain exclusions and limitations.
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