Coverage Policies

Use the index below to search for coverage information on specific medical conditions.

QualChoice reserves the right to alter, amend, change or supplement medical policies as needed. QualChoice reviews and authorizes services and substances. CPT and HCPCS codes are listed as a convenience and any absent, new or changed codes do not alter the intent of the policy.

Note: For Arkansas State or Public School employees, services subject to pre-authorization are managed by Active Health Management, as noted in their Summary Plan Description.

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Medical Providers: Payment for care or services is based on eligibility, medical necessity and available benefits at time of service and is subject to all contractual exclusions and limitations, including pre-existing conditions if applicable.

Future eligibility cannot be guaranteed and should be rechecked at time of service. Verify benefits by signing into My Account or calling Customer Service at 800.235.7111 or 501.228.7111.

QualChoice follows care guidelines published by MCG Health.

INDEX:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Effective Date: 08/06/2004 Title: Non Face-to-Face Services
Revision Date: 01/01/2020 Document: BI063:00
CPT Code(s): 99441-99444, 99446-99449, 93293-93299, 98966-98969, 98970, 98971, 98972, 99421, 99422, 99423, G2061, 2062, G2063, 99451-99452, 99484, 99492, 99493, 99494
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

1)    Health Care Professionals will often contact and respond to patients by telephone, email, or other electronic means.

2)    These services are considered part of the overall services rendered by a Health Care Professional and are not covered under normal circumstances. 

3)    Please refer to BI529 for telemedicine services.

4)    Telephone recording and analysis of various cardiac monitoring and pacing devices are covered.


Medical Statement

1)    Non face-to-face services, such as by telephone, email or other electronic means are generally, are not covered under normal circumstances.

2)    All services that are not provided by a provider physically located with the patient are considered non-face-to-face.

3)    Following non-face-to-face services to promote behavioral health integration are covered without prior authorization (medical records for these services may be requested for review to ensure CMS documentation requirements):

a) Interprofessional services (99446-99449 and 99451, 99452),

b) Behavioral Health Care coordination (99484),

c) Psychiatric Collaborative Care Management (99492, 99493 and 99494).

4)    Telephonic monitoring of cardiac pacing and monitoring devices are covered.

5)    Please refer to BI529 for telemedicine services.

Codes Used In This BI:

93293

Transtelephonic rhythm strip pacemaker eval, sgl, dual, or mult lead pacemaker syst, incl recording w/ & w/out magnet applic w/analysis, rvw & rpt by physician or other qual hlth care prof, up to 90 days

93294

Interrogation dvc eval (remote), up to 90 days; sgl, dual, or mult lead pacemaker system, or leadless pacemaker system w/interim analysis, rvw & rpt by a physician or other qual hlth care prof (code revised 1/1/19)

93295

Interrogation dvc eval (remote), up to 90 days; sgl, dual, or mult lead implantable defibrillator system w/interim analysis, rvw & rpt by a physician or other qual hlth care prof

93296

Interrogation dvc eval (remote), up to 90 days; sgl, dual, or mult lead pacemaker system, leadless pacemaker system, or implantable defib system, remote data acquisition(s), receipt of transmissions & tech rvw, tech support & distrib of results (code revised 1/1/19)

93297

Interrogation dvc eval (remote), up to 30 days; implantable cardio physiologic monitor system, incl analysis of 1 or more recorded physiologic cardio data elements frm all internal & external sensors, analysis, rvw & rpts by a physician or other qual hlth care prof (code revised 1/1/19)

93298

Interrogation dvc eval (remote), up to 30 days; subcutan cardiac rhythm monitor system, incl analysis of recorded heart rhythm data, analysis, rvw(s) & rpts by a physician or other qual hlth care prof (code revised 1/1/19)

93299

Interrogation dvc eval (remote), up to 30 days; implantable cardio physiologic monitor system or SC cardiac rhythm monitor syst, remote data acquisition(s), receipt of transmissions & techn rvw, tech support & distribution of results (code revised 1/1/19) (deleted code eff 01/01/2020

98966

Telephone assessment & mgmt svc provided by a qual nonphysician hlth care prof to an estab pt, parent, or guardian not originating frm a related assessment & mgmt svc provided w/in the prv 7 dys nor leading to an assessment & mgmt svc or proc w/in the nxt 24 hrs or soonest avail appt; 5-10 min of med discussion

98967

Telephone assessment & mgmt svc provided by a qual nonphysician hlth care prof to an estab pt, parent, or guardian not originating frm a related assessment & mgmt svc provided w/in the prv 7 dys nor leading to an assessment & mgmt svc or proc w/in the nxt 24 hrs or soonest avail appt; 11-20 min of med discussion

98968

Telephone assessment & mgmt svc provided by a qual nonphysician hlth care prof to an estab pt, parent, or guardian not originating frm a related assessment & mgmt svc provided w/in the prv 7 dys nor leading to an assessment & mgmt svc or proc w/in the nxt 24 hrs or soonest avail appt; 21-30 min of med discussion

98969

Online assessment & mgmt svc provided by a qual nonphysician hlth care prof to an estab pt or guardian, not originating frm a related assessment & mgmt svc provided w/in the prv 7 dys , using the Internet or similar electronic communications network Deleted code eff 01/01/2020

98970

QNHP ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MIN

98971

QNHP ONLINE DIGITAL E/M SVC EST PT <7 D 11-20MIN

98972

QNHP ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MIN

99421

ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES

99422

ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES

99423

ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES

99441

Telephone E/M svc by physician or other qual hlth care prof who may rpt E/M svcs provided to an estab pt, parent, or guardian not originating frm a related E/M svc provided w/in the prv 7 dys nor leading to an E/M svc or proc w/in the nxt 24 hrs or soonest avail appt; 5-10 min of med discussion

99442

Telephone E/M svc by physician or other qual hlth care prof who may rpt E/M svcs provided to an estab pt, parent, or guardian not originating frm a related E/M svc provided w/in the prv 7 dys nor leading to an E/M svc or proc w/in the nxt 24 hrs or soonest avail appt; 11-20 min of med discussion

99443

Telephone E/M svc by physician or other qual hlth care prof who may rpt E/M svcs provided to an estab pt, parent, or guardian not originating frm a related E/M svc provided w/in the prv 7 dys nor leading to an E/M svc or proc w/in the nxt 24 hrs or soonest avail appt; 21-30 min of med discussion

99444

Online E/M svc provided by a physician or other qual hlth care prof who may rpt E/M svcs provided to an estab pt or guardian, not originating frm a related E/M svc provided w/in the prv 7 dys, using the Internet or similar electronic communications ntwk Deleted code eff 01/01/2020

99446

Interprofessional telephone/Internet/electronic health record assessment & mgmt svc provided by a consultative physician, incl a verbal & written rpt to the pt`s treating/req physician or other qual hlth care prof; 5-10 mn of medical consult discussion & rvw (code revised 1/1/19)

99447

Interprofessional telephone/Internet/electronic health record assessment & mgmt svc provided by a consultative physician, incl a verbal & written rpt to the pt`s treating/req physician or other qual hlth care prof; 11-20 mn of medical consult discussion & rvw (code revised 1/1/19)

99448

Interprofessional telephone/Internet/electronic health record assessment & mgmt svc provided by a consultative physician, incl a verbal & written rpt to the pt`s treating/req physician or other qual hlth care prof; 21-30 mn of medical consult discussion & rvw (code revised 1/1/19)

99449

Interprofessional telephone/Internet/electronic health record assessment & mgmt svc provided by a consultative physician, incl a verbal & written rpt to the pt`s treating/req physician or other qual hlth care prof; 31 mn or more of medical consult discussion & rvw (code revised 1/1/19)

99451

Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient`s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time.

99452

Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified healthcare professional. It requires a minimum of 16 minutes. and can be billed every 14 days when this time requirement is met.

99484

Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional time, per calendar month

99492

Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional

99493

Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional

99494

Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (List separately in addition to code for primary procedure)

G2061

Qualified nonphysician health care professional online assessment, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

G2062

Qualified nonphysician health care professional online assessment service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

G2063

Qualified nonphysician qualified health care professional assessment service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes


Reference

Addendum:

Effective 01/01/19: Made reference to BI529 for telemedicine services.

2019 Code Updates: Updated code description for CPT codes 93294, 93296, 93297, 93298, 93299, 99446, 99447, 99448, and 99449.

Effective 01/01/2020: Code update – Added new codes and their descriptions 98970, 98971, 98972, 99421, 99422, 99423, G2061, G2062 and G2063 eff 01/01/2020.  Added these codes to the search box as well.  Deleted codes 98969, 99444 and 93299 eff 01/01/2020.

Effective 03/01/2021:  Following non-face-to-face services to promote behavioral health integration are covered: Interprofessional services (99446-99449 and 99451, 99452), Behavioral Health Care coordination (99484), and Psychiatric Collaborative Care Management (99492, 99493 and 99494).  These services do not require prior authorization. However, medical records may be requested to ensure CMS documentation requirements are being met.

Added codes 99451, 99452, 99484, 99492, 99493, 99494 to the search box.


Application to Products

This policy applies to all health plans and products administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet.  Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) or Certificate of Coverage (COC) for those plans or products insured by QualChoice.  In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC or COC, the SPD, EOC, or COC, as applicable, will prevail.  State and federal mandates will be followed as they apply.


Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
This policy has recently been updated. Please use the index above or enter policy title in search bar for the latest version.