SPECIAL BULLETIN COVID-19 #84: Telehealth and Virtual Patient Communications Clinical Policy Modifications – Maternal Support Services Provided by Local Health Departments

Thursday, May 7, 2020

Background and General Guidance

NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and Health Choice beneficiaries. 

These temporary changes are retroactive to March 10, 2020 and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded. 

This Bulletin temporarily enables eligible local health departments to deliver maternal support services via telemedicine in light of social distancing measures that may prevent in-person visits.    

NC Medicaid has eliminated the restriction that telehealth services cannot be conducted via “video cell phone interactions.” These services can now be delivered via any HIPAA-compliant, secure technology with audio and video capabilities, including (but not limited to) smart phones, tablets and computers.

In addition, the Office of Civil Rights (OCR) at Health and Human Services (HHS) recently issued guidance noting that “covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.”

NC Medicaid will continue to evaluate telemedicine policies and will release temporary flexibilities and guidance as needed throughout the state of emergency. 

Specific guidance related to billing and coding is detailed in the section “Temporary Modifications to Attachment A.” All claims are subject to audit.

Definitions

  • Telemedicine is the use of two-way real-time interactive audio and video to provide care and services when participants are in different physical locations. 
  • Virtual Patient Communication is the use of technologies other than video to enable remote evaluation and consultation support between a provider and a patient or a provider and another provider. Covered virtual patient communication services include telephone conversations (audio only); virtual portal communications (e.g., secure messaging); and store and forward (e.g., transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).

Maternal Support Services Provided by Local Health Departments Modifications 

The following are policy modifications:

  • NC Medicaid encourages local health departments to provide maternal support services in-person when it is safe to do so; however, if an in-person or home visit is not feasible, eligible providers may conduct maternal support services with new or established patients via telemedicine (two-way real-time, interactive audio video). Maternal support services conducted via virtual patient communication (telephone, virtual portal communications, etc.) will not be eligible for reimbursement.
  • Eligible maternal support services include: 
    • Home visit for newborn care and assessment 
    • Home visit for postnatal assessment 
    • Childbirth education classes (individual or group classes)
  • Eligible providers include local health departments whereby the service is rendered via telemedicine by:
    • A registered nurse (for home visit for newborn and postnatal assessment, only); or,
    • A certified childbirth educator (for childbirth education classes, only).
  • For the newborn and postnatal assessments, providers must document on the assessment tool that the service was conducted via telemedicine.
  • See NC Medicaid Clinical Coverage Policies 1M-2; 1M-4; and, 1M-5 for further details and guidance regarding the delivery of these services.
  • Patients are not required to obtain prior authorization prior to receiving services via telemedicine.

See “Temporary Modifications to Attachment A” for additional coding and billing guidance.

Temporary Modifications to Attachment A: Claims-Related Information

Retroactive to March 10, 2020, through the conclusion of the state of emergency related to COVID-19, NC Medicaid is temporarily modifying Attachment A of its Telemedicine and Telepsychiatry Clinical Coverage Policy 1-H to better enable the delivery of remote care to Medicaid beneficiaries. Provider(s) shall comply with the “NCTracks Provider Claims and Billing Assistance Guide,” Medicaid Bulletins, fee schedules, NC Medicaid’s clinical coverage policies and any other relevant documents for specific coverage and reimbursement for Medicaid and NC Health Choice.

A. Claim Type

Professional (CMS-1500/837P transaction)

B. International Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) and Procedural Coding System (PCS)

Provider(s) shall report the ICD-10-CM and Procedural Coding System (PCS) to the highest level of specificity that supports medical necessity. Provider(s) shall use the current ICD-10 edition and any subsequent editions in effect at the time of service. Provider(s) shall refer to the applicable edition for code description, as it is no longer documented in the policy.

C. Code(s)

C.1 The following maternal support services codes may be billed by a local health department when provided via telemedicine to a new or established patient and rendered by an eligible provider (as noted below).

Code

Description (See 2020 CPT Code Book for Complete Details)

99501

A home visit for postnatal assessment and follow-up care is designed to deliver health, social support, and/or educational services directly to families in their homes. A home visit for postnatal assessment and follow-up care is a means to follow up on the mother’s health; to counsel on family planning and infant care; and to arrange for additional appointments for the infant and mother.

Eligible provider: must be rendered by a registered nurse.

99502

A home visit for newborn care and assessment delivers health, social support, and/or educational services directly to families in their homes. A home visit for newborn care and assessment is a means to follow up on the infant’s health; to counsel on infant care; to follow up on newborn screening; and to arrange for additional appointments for the infant.

Eligible provider: must be rendered by a registered nurse.

S9442

Childbirth education is a series of classes designed to help pregnant women and their support person to understand the changes experienced during pregnancy, to prepare for the labor and delivery experience, and to understand the postpartum period, including, but not limited to, the importance of proper postpartum care for the mother and the child.

Eligible provider: must be rendered by a certified childbirth educator who is eligible to bill for this service.

Additional Billing Guidance

  • 99501 and 99502: Providers must document on the assessment tool that the service was conducted via telemedicine.

D. Modifiers

Provider(s) shall follow applicable modifier guidelines.

  • Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive audio-visual communication. 
  • Modifier CR (catastrophe/disaster related) must be appended to all claims for CPT codes listed in this policy.

E. Billing Unit

Provider(s) shall report the appropriate code(s) used which determines the billing unit(s).

F. Place of Service

Telemedicine claims for 99501 and 99502 should be billed with POS ‘12’ for home; telemedicine claims for S9442 should be billed with POS ’71’ for public health clinic.

G. Copayments

H. Reimbursement

Provider(s) shall bill their usual and customary charges. For a schedule of rates, refer to https://medicaid.ncdhhs.gov. When the GT modifier is appended to a code billed for professional services, the service is paid at 100% of the allowed amount of the fee schedule.

  • Reimbursement for these services is subject to the same restrictions as face-to-face contacts (such as place of service, allowable providers, multiple service limitations, prior authorization) unless otherwise noted in this policy.

Additional Resources

Contact

NCTracks Contact Center: 800-688-6696