For the Alliance Provider Network: Guidance on Telehealth Services

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The Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC) have issued new guidance regarding the provision of telehealth services during the COVID-19 pandemic. In order to support social distancing and ensure the safety of members and providers, Alliance providers must take steps to allow members to obtain health care via telehealth when medically appropriate to do so.

Telephonic or Video Visits: Any clinician eligible to bill for office visits may conduct a telephone or video visit with a patient in lieu of an office visit by way of a HIPAA compliant platform that supports provider to patient communication for patient care. Such visits must last at least 5 minutes, must be documented in the patient’s medical record and are subject to oral or written consent by the patient. Per DHCS guidance, FQHCs and RHCs are allowed to count video visits and telephone visits the same as in-office visits for the purpose of prospective payment.

Required Codes for Telehealth Services

  • Existing face-to-face codes apply when a Medi-Cal provider/clinician is billing the Alliance for video/ telephonic Example codes for the PCP Setting: 99201-99204, 99212-99214
  • The CPT or HCPCS code(s) must be billed using:
    • Place of Service Code “02”
  • Use appropriate telehealth modifiers
    • Synchronous, interactive audio and telecommunications systems: Modifier 95
    • Asynchronous store and forward telecommunications systems: Modifier GQ

Important Clarification: Last week, the Alliance issued guidance for providers to bill 99441-99443 and 98966- 98968 for telehealth visits. Due to the updated guidance from DHCS and DMHC, as detailed above, please re-bill for these services using the applicable face-to-face code and indicated place of service and modifier.

Alliance Provider Services and Claims staff are available to assist with questions. Please contact 831-430-5504 to speak with a Provider Relations Representative.

Please note: not all services are appropriate for telehealth (for example, benefits or services that require direct visualization or instrumentation of bodily structures). The Alliance will communicate any new or additional guidance to allowable telehealth services as it becomes available.