In response to the COVID-19 crisis, BWC is initiating temporary policy changes that will allow flexibility in the provision of care to injured workers. These changes will be effective until the state of emergency related to COVID-19 is lifted within the state where the injured worker resides.
Under the current telemedicine policy, the home is excluded as an origination site. However, during this period of crisis, BWC will temporarily permit the injured worker’s home as an acceptable origination site. Providers may synchronously render and bill any of the 40-designated telemedicine services, including but not limited to evaluation and management (E&M) services 99212-99215, 99241-99245, 99307-99310 and psychotherapy services 90832-90838. For a complete list of telemedicine designated CPT codes identified with the -95 modifier, please refer to the 2020 Professional Provider Fee Schedule.
BWC’s current policy permits telephone services utilizing CPT codes 99371-99373. The code descriptions and related policy can be found through the following Billing and Reimbursement Manual link. BWC will temporarily permit MCOs to authorize the use of telephone visits in lieu of face-to-face visits for injured workers in a state of crisis or who are at risk to travel to a face-to-face visit during the state of emergency.
Prior Authorization Requirements
Telephone services and psychological services require prior authorization from the MCO. BWC will waive the prior authorization requirement for telephone services when:
• The provider substitutes a telephone call in lieu of delivering a face-to-face visit for a previously approved psychological counseling service; or
• A provider eligible to render an E&M service substitutes a telephone call in lieu of the face-to-face E&M visit when the provider determines that the visit would create an unnecessary or increased risk of exposure to either the injured worker or to the provider.
Billing and Reimbursement
Synchronous telemedicine services are billed using the appropriate CPT code in the Professional Provider Fee Schedule designated with a -95-telemedicine modifier. For telephone services, providers would bill the most applicable CPT code 99371, 99372 or 99373. Reimbursement for these telemedicine and telephone services can be found in the 2020 Professional Provider Fee Schedule. Telemedicine services are reimbursed at the same rate as the equivalent faceto-face visits. To be eligible for reimbursement when delivering telehealth services, providers must have an active license in the state where the injured worker is located.
Documentation requirements will follow BWC’s Billing and Reimbursement Manual. Under this temporary policy change, providers will also be required to reference the following:
• The current state of emergency for COVID-19; and
• The intention to limit the exposure of the injured worker or provider to COVID-19; and
• The delivery means of the care, either through synchronous telemedicine or telephone delivery; and Date: March 16, 2020
• The location (origination site) of the injured worker, including the state if the injured worker does not reside in Ohio.
Equipment Needed to Facilitate Telehealth Services
Under this policy, reimbursement is never covered for a cell phone, internet connection or any other equipment or service needed to establish the telephone call or synchronous visit.
Information provided by www.bwc.ohio.gov