​​​​AmeriHealth New Jersey telemedicine changes

April 21, 2022

​In accordance with recent changes to New Jersey state law, AmeriHealth New Jersey is modifying its telemedicine position.

Eligibility

Effective April 1, 2022, AmeriHealth New Jersey will only waive member cost-share on telemedicine visits rendered by a participating provider which result in an order for a COVID-19 test.

For non-participating providers:

  • PPO & POS plans: Effective July 1, 2022, telemedicine services performed by non-participating providers are not covered.
  • EPO & HMO plans: Effective September 1, 2021, telemedicine services performed by non-participating providers are not covered.

Audio-only telemedicine claims

Effective July 1, 2022, audio-only, non-behavioral health claims billed by participating providers will reimburse at 50 percent of the fee for an in-office visit.

Providers must report the appropriate CPT® code with the modifier (modifier 93 or FQ) to identify the claim as audio-only. Please note: audio-only telemedicine reported with procedure codes 99441, 99442, and 99443 will result in a claim denial as inappropriately billed.

For further information on the coverage of telemedicine, please visit our Medical and Claim Payment Policy portal. We will post an updated Policy Notification shortly to describe our upcoming telemedicine coverage.

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