COVID-19 Telehealth Services Policy Update to PT, OT and ST Coverage
On Friday, March 13, 2020, President Donald Trump declared a national emergency due to coronavirus disease 2019 (COVID-19) and Governor Henry McMaster declared a state of emergency for the state of South Carolina. As a part of the state’s preparation and response to COVID-19, the South Carolina Department of Health and Human Services (SCDHHS) is announcing additional temporary modifications to policies related to telehealth coverage.
Reimbursement for the telephonic services addressed below is available if the interaction with a Healthy Connections Medicaid member includes at least one telephonic component. Interactions that also include video interaction may also be billed, but other forms of electronic communication, such as email and instant and text messaging, are not eligible for reimbursement. Services provided pursuant to the current SCDHHS telemedicine coverage policy should continue to be billed according to those guidelines. The audio and visual components of the interaction must include sufficient quality and/or resolution for the provider to effectively deliver the care being administered.
The telehealth policy modifications outlined below were developed in consultation with clinical professionals, regional payers, actions taken by state licensing boards and other Medicaid programs, and are intended to balance immediate treatment needs that are not appropriate for deferral with the safety and efficacy of remote service delivery. In all circumstances, the services identified below must meet standard requirements for medical necessity.
SCDHHS will begin accepting claims for these policy changes beginning April 15, 2020, for dates of service beginning March 27, 2020.
Telephonic Care Provided by Physical, Occupational and Speech Therapists
SCDHHS will reimburse for the services indicated below when they are rendered by a physical therapist, occupational therapist or speech therapist. These services may only be provided to an established patient. Up to three encounters will be allowed every 30 days, and services may be provided regardless of the Medicaid member’s location.
|98966||Telephonic Assess/Mgmt; 5-10 minutes, non-physician|
|98967||Telephonic Assess/Mgmt; 11-20 minutes, non-physician|
|98968||Telephonic Assess/Mgmt; 21-30 minutes, non-physician|
Delivery of Physical, Occupational and Speech Therapy via Telehealth
Additionally, SCDHHS will reimburse for the codes specified below for therapy related to the following, when provided via telehealth:
- Surgical procedure in the preceding 120 days
- Acute trauma, such as fractures or dislocations
- Spinal or neurological disorders, such as brachial plexus, torticollis muscular dystrophy, and hereditary sensory motor neuropathy
- Juvenile idiopathic arthritis
- Acute hip disorders, such as Legg-Calve-Perthes disease and developmental dysplasia of the hip
Therapy providers may also provide services via telehealth if the provider has determined and documented that deferring care would be clinically detrimental for therapy related to the following:
- Congenital abnormalities;
- Cerebral palsy;
- Genetic disorders;
- Down syndrome;
- Autism spectrum disorder;
- Neurodevelopment disorders;
- Apraxia; and,
- Global development delays.
For the clinical circumstances listed above, SCDHHS will reimburse for the following CPT codes, with a GT modifier, when delivered via telehealth: 97530, 97110 and 92507. Providers should note that these flexibilities are provided for the licensed provider authorized to perform independent practice, and does not extend to assistants, technicians or provider extenders that may otherwise be utilized in a face-to-face setting.
This bulletin applies to all Medicaid providers, as well as providers offering services to participants in South Carolina’s Individuals with Disabilities Education Act (IDEA), Parts B and C.
Additional guidance and modifications to coverage policy will be communicated in future bulletins as needed.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.