Telehealth visits (virtual services) allow members to receive primary, specialist or urgent care using a computer, phone and/or tablet.
All members have access to expanded telehealth (virtual services). In addition, most members have standard telehealth benefits. (See the Standard telehealth section below.)
Telehealth services can be provided if the services:
- Are safely and effectively delivered virtually
- Meet existing coverage criteria, including pre-authorization requirements and medical necessity
- Are rendered by a provider who meets our credentialing criteria, including:
- Providers must be licensed in both the state where the member is located, as well as the state where the provider is physically located.
- Providers must physically provide telehealth services within our service area (home or clinic setting).
- Providers who conduct telehealth services from their homes within our service area can use a registered agent address.
- Providers who reside outside our service area must conduct telehealth services from a location within our service area (e.g., clinic location).
- The provider’s address cannot be a P.O. box.
If you are a provider located out of the Asuris service area and employed by a provider group in the Asuris service area, you are not eligible for credentialing or contracting with Asuris.
Learn more about our credentialing requirements for providers who conduct telehealth services.
Note: Effective April 1, 2022, through December 31, 2022, telehealth services may be covered pre-deductible for members on a participating administrative services only (ASO) group with a health saving account- (HSA-) eligible plan.
To support our members, we cover expanded telehealth services. See the tab above for standard telehealth services.
Complete telemedicine training: Washington-based telemedicine providers (those who provide clinical services through telemedicine, other than a physician licensed under chapter 18.57 RCW or chapter 18.71 RCW) must complete telemedicine training in accordance with Senate Bill 6061, Telemedicine Training. The training may be provided by the Washington State Telemedicine Collaborative, hospitals and other health care facilities, continuing education courses or health care professional boards or commissions. A health care professional who completes the training must sign and retain an attestation.
Reimbursement |
Note: Please continue to refer to the Clinical Edits by Code List and our member’s benefits for non-covered services. Verify member’s benefits using Availity Essentials. |
Claims submission |
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Reimbursement |
Note: Please continue to refer to the Clinical Edits by Code List and our member’s benefits for non-covered services. Verify member’s benefits using Availity Essentials. |
Claims submission |
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Standard telehealth services are identified in our policies:
- Virtual Care (Administrative #132) reimbursement policy.
- Virtual Care (Administrative #132) Medicare Advantage reimbursement policy.
If a member has a standard telehealth benefit, we will continue to cover the medical and behavioral health codes, as outlined in our Virtual Care policies. Telehealth services that are included in the policy will apply to the member’s telehealth benefit, if applicable.
You can view standard telehealth benefits when performing an eligibility and benefits inquiry on Availity Essentials. When selecting the “Professional (Physician) Visit – Office” benefit service type (BST), the “Professional (Physician) Visit – Home” BST result includes the “Professional (Physician) Visit – Office” BST. To view telehealth benefits, scroll down to “Professional (Physician) Visit – Home” in the eligibility and benefits results. You may also need to view the benefit booklet for additional details.
Reimbursement | Providers will be reimbursed for standard telehealth services based on Senate Bill 5385, Telemedicine Payment Parity, where applicable. |
Claims submission |
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Reimbursement | Providers will be reimbursed for standard telehealth services based on the facility RVU reimbursement rate. |
Claims submission |
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In alignment with CMS’ temporary guidelines (PDF), we allow for outpatient facility billing for HCPCS Q3014 Telehealth originating site facility fee when the originating site for telemedicine is the Medicare Advantage member’s home and the member is registered as an outpatient of the hospital for purposes of receiving telehealth services billed by the provider. Note: For Individual and group members, HCPCS Q3014 is only reimbursable when the member is in the health care facility during the virtual visit.
The following companies offer HIPAA-compliant telehealth platforms:
CMS has indicated that providers can include diagnosis codes on telehealth claims for risk adjustment purposes. For risk adjustment, telehealth visits must be conducted using audio and video.
If captured using audio and video, member reported blood pressure readings will count toward gap closures and be included in risk adjustment.
As with face-to-face visits, diagnosis codes included on claims must have sufficient documentation and may be subject to review. Refer to the Risk Adjustment section of our website for additional information about documentation requirements.
As a participating provider, you can conduct advance care planning (ACP) conversations with your patients via telehealth.
In light of the demand triggered by COVID-19 and to better support our Medicare Advantage members, we are now covering goals of care/ACP conversations at no cost share ($0 copay), regardless of the visit type or place of service. This benefit enhancement applies to telehealth (conducted via audio and video) and in-person visits. To ensure members are supported if their health status and/or wishes regarding care planning change, the benefit covers one ACP conversation per day with no annual limit.
Teledentistry services can be provided if:
Your interaction with the member qualifies as a teledentistry visit. Please refer to the American Dental Association’s Policy on Teledentistry for guidance.
Member benefits and dental provider reimbursement:
- Claims performed via teledentistry are considered the same as in-person visits and are paid at the same rate as in-person visits.
- Standard cost shares and plan limitations apply. Any paid amounts will accumulate to the annual maximum, if applicable.
- View the member’s plan benefits on Availity Essentials.
View all COVID-19 updates and resources.