This article was revised on May 14, 2020, to update the effective timeline.
AmeriHealth is committed to providing our members with access to the care they need. As COVID-19 has escalated into a pandemic, we are working to make sure that our members can receive appropriate testing and treatment for the virus causing COVID-19 if needed.
We encourage all AmeriHealth members to visit our dedicated
AmeriHealth New Jersey and
AmeriHealth Pennsylvania COVID-19 webpages regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.
Well visits using telemedicine tools
Effective March 6, 2020, through June 30, 2020, providers may use telemedicine services to perform preventive well visits for commercial members. This policy change may be reevaluated during the public health emergency.
A preventive well visit performed through telemedicine is eligible for reimbursement for new and established pediatric and adult patients when it meets the criteria set forth below:
- The well visit is performed through interactive, synchronous (real-time) two-way audio and/or video communications, and includes all components that can be performed through telemedicine (e.g., history, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures); and
- The well visit will include a subsequent office-based visit for the completion of the physical examination component of the preventive well visit. The subsequent office-based visit is not eligible for separate reimbursement consideration. Reimbursement for the subsequent office-based visit is included in the telemedicine preventive well visit.
- Eligible professional providers performing the subsequent office-based visit for the completion of the physical examination component must report procedure code 99429 (Unlisted preventive medicine service) along with a narrative that indicates the service is for completion of the well visit and listing the date of the initial telemedicine visit. For example, “Completion of well visit from XX/XX/2020”.
The patient’s medical record must reflect the medical necessity for the care provided. These medical records may include but are not limited to: records from the professional provider’s office, hospital, nursing home, home health agencies, therapies, and test reports.
Billing and coding
Eligible professional providers performing components of the preventive well visits, as appropriate, through interactive, synchronous (real-time) two-way audio and video communications must report the appropriate procedure code, appropriate modifier, and place-of-service (POS) code 02 (Telehealth), to ensure payment of eligible telemedicine services.
For a list of eligible procedure codes and modifiers, please review the policy announcement for
AmeriHealth New Jersey or
The policies affected by this change include:
For more information about the AmeriHealth position on COVID-19, please review the following resources: