Telehealth Services

Purpose  

Effective immediately, Aetna Better Health of New Jersey (ABHNJ) allows reimbursement for telemedicine/telehealth performed within the provider’s scope of practice as regulated by the State of New Jersey. This is in effect for the duration of the COVID-19 public health emergency only.

Definition 

Telemedicine and Telehealth: Telemedicine and telehealth are approved modes of delivering service under NJ FamilyCare. Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.

Telemedicine services include telephone calls and interactive visits using a computer, tablet or cell phone with two-way immediate communication with or without a camera.  In response to COVID-19 it is preferred to use these methods of telehealth rather than in-person care. Providers are encouraged to use publicly available apps with caution.

According to CMS's Office of Civil Rights (OCR), Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, and Skype are acceptable for telehealth services, but Facebook Live, Twitch, TikTok, and similar video communication applications are not acceptable because they are public-facing. Providers are still encouraged to exercise caution as to who is in the room and able to view/listen in on any televisit to preserve patient privacy. 

Documentation Requirements 

Documentation requirements for telehealth services are the same as in-office visits. Any information used to make a medical decision about the patient should be documented. Providers should typically document the start and end time of the telehealth encounter since some codes are time based. Best practice suggests including the following information in the documentation:

  • A statement that the service was provided through telehealth,
  • location of the patient and provider, and
  • names and roles of any other persons participating in the telehealth service.

Telehealth Accessibility Solutions for Deaf/Hard of Hearing Individuals

Accessibility features in telehealth platforms are crucial in ensuring that deaf and hard of hearing (DHH) individuals have access to healthcare while maintaining the safety of medical providers and the general public during the COVID-19 pandemic

Aetna Better Health of New Jersey offers accessibility solutions for DHH members through Akorbi, who provides a full range of interpretation services for telehealth visits that meet the needs of both DHH members and the provider. Akorbi offers an adaptive platform that includes over-the-phone interpretation and video interpretation services. Aetna Better Health does not require prior authorization for services provided through Akorbi.

  • Schedule an interpreter
    • Call Aetna Better Health of New Jersey’s Member Services at 1-855-232-3596 to schedule interpreter services for DHH individuals with Akorbi. We request at least a three-day notice. Although same-day appointments can be accommodated, they are not guaranteed due to increase in demand.
  • Additional Resources
    • Review Aetna Better Health’s telehealth guidance at www.aetnabetterhealth.com/newjersey/providers/telehealth.
    • Get tips for treating DHH individuals during COVID-19 from the Division of the Deaf and Hard of Hearing at https://www.state.nj.us/humanservices/ddhh/.

Reimbursement Policy 

ABHNJ will authorize and reimburse for any service provided by a health care provider who is validly licensed, certified, or registered with the Department of Health (annually) to provide such services in the State of New Jersey so long as either the provider or patient are located in New Jersey at the time the services were provided. Services must be provided in compliance with existing requirements under law or regulation. Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate. 

Billing Procedures

Health care providers may bill for any Medicaid billable service using the same billing codes and rates that are provided for face-to-face services. There is no need to use any additional procedure codes or additional modifiers. The use of GT suggested in the original pilot has been discontinued by the Centers for Medicare and Medicaid Services (CMS) and is not necessary for billing.

Providers should use place of service code POS 02 to indicate telehealth. For telephone services only, codes are time-based; physicians should use service codes 99441-99443 and non-physicians should use 98966-98968.

Aetna Better Health of New Jersey is waiving co-pays for telehealth visits for behavioral and mental health counseling for MLTSS and DDD members. This is in effect for the duration of the COVID-19 public health emergency. For questions, call member services at 1-855-232-3596, TTY 711

CPT CODES:

98966

98967

98968

99441

99442

99443 

Well-Visit Codes

99391 - PER PM REEVAL EST PAT INFANT

99392 - PREV VISIT EST AGE 1-4

99393 - PREV VISIT EST AGE 5-11

99394 - PREV VISIT EST AGE 12-17

99395 - PREV VISIT EST AGE 18-39

Telehealth Reimbursement FAQs          

Please view our FAQs on telehealth below or download a copy.

Providers must be validly licensed to practice in the state of NJ.

Telemedicine services shall be provided using interactive, real-time, two-way communication technologies with proper encryption.

Providers may use asynchronous store-and-forward technology to allow for the electronic transmission of images, diagnostics, data, and medical information. Providers may use interactive, real-time, two-way audio in combination with asynchronous store-and-forward technology, without video capabilities, if, after accessing and reviewing the patient’s medical records, the provider determines that the provider is able to meet the same standard of care as if the health care services were being provided in person.

The identity, professional credentials, and contact information of a health care provider providing telemedicine or telehealth services shall be made available to the patient during and after the provision of services. The contact information shall enable the patient to contact the health care provider, or a substitute health care provider authorized to act on behalf of the provider who provided services, for at least 72 hours following the provision of services.

No. Any health care provider providing health care services using telemedicine or telehealth shall be subject to the same standard of care or practice standards as are applicable to in-person settings. If telemedicine or telehealth services would not be consistent with this standard of care, the health care provider shall direct the patient to seek in-person care.

Diagnosis, treatment, and consultation recommendations, including discussions regarding the risk and benefits of the patient’s treatment options, which are made through the use of telemedicine or telehealth, including the issuance of a prescription based on a telemedicine or telehealth encounter shall be held to the same standard of care or practice standards as are applicable to in-person settings.

The prescription of Schedule II controlled dangerous substances through the use of telemedicine or telehealth shall be authorized only after an initial in-person examination of the patient, as provided by regulation, and a subsequent in-person visit with the patient shall be required every three months for the duration of time that the patient is being prescribed the Schedule II controlled dangerous substance.

No, an initial in-person visit is not required, provided that the health care provider is using interactive, real-time, two-way audio and video technologies when treating the patient and the health care provider has first obtained written consent for the waiver of these in-person examination requirements from the minor patient’s parent or guardian.

Providers are required to keep a complete record of the patient’s care and shall comply with all applicable State and federal statutes and regulations for recordkeeping, confidentiality, and disclosure of the patient’s medical record.

No. Providers must determine they are able to provide the same standard of care using telemedicine or telehealth prior to initiating contact with a patient for the purpose of providing services.

In accordance with the 2019 State of New Jersey Department of Human Services Division of Medical Assistance and Health Services (DMAHS) Health Maintenance Organization (HMO) Contract, ABHNJ reimburses telehealth visits at same rate as in-office visits. View the list of codes that should be billed for telehealth.

 

Contact

If you have questions, please contact your Provider Relations representative.