​​Important updates to AmeriHealth Pennsylvania telemedicine policy for commercial members

October 12, 2021

At AmeriHealth, we know telemedicine benefits members and health care providers alike. That is why we support it as a reliable complement to in-person care and continue to keep you informed as updates, like those outlined below, are made to our telemedicine policies. We will continue to re-evaluate these updates and changes throughout the COVID-19 public health emergency.

This information does not apply to AmeriHealth New Jersey members.

Update on Behavioral Health and Speech Therapy Coverage

  • Behavioral Health visits via telemedicine will continue to be covered with no member cost-sharing for a COVID-19 diagnosis. The previous announcement made on October 1, 2021, regarding a change in behavioral health coverage has been put on hold due to a rise in COVID-19 cases. Behavioral Health visits without a COVID-19 diagnosis are covered and are subject to the member's cost-share.
  • Speech Therapy services via telemedicine continue to be covered. Initially, on July 1, 2021, we removed speech therapy coverage from the telemedicine benefit. Due to the rise in cases, we are reinstating telemedicine coverage for speech therapy and are retroactively adjusting claims for speech therapy services provided between July 1, 2021, and September 23, 2021.

Reminders about Urgent Care Centers

  • Visits to Urgent Care Centers are not covered via telemedicine.
  • COVID-19 tests at an Urgent Care Center should be coded as an in-person visit, using the S code and presence of a test for reimbursement, even if intake questions were asked on a phone or video call.
  • Members are encouraged to first turn to their primary care doctors for telemedicine services of an urgent nature, when appropriate. In those cases, please code as a telemedicine visit.

Verifying benefits

Be sure to verify members' benefits in PEAR Practice Management on the PEAR portal.

NOTE: The changes outlined in this article apply to AmeriHealth Pennsylvania commercial members who seek telemedicine services. AmeriHealth New Jersey members are subject only to the COVID-19 telemedicine polic​​y for the duration of the public health emergency.