Applies to:

Group commercial HMO, EPO, POS and PPO plans

Individual commercial MyPriority^® plans

Medicare

Medicaid Healthy MI Plan

Medical policy

• Telemedicine - 91604

Refer to the medical policy for medical necessity criteria, services not covered as virtual services, and coding information.

Use of virtual visits for behavioral health services

From the medical policy, page 6:

Telemedicine visits for acute life-threatening medical conditions or intensive psychotherapy may be restricted to hosted sites where the patient can be monitored or assisted by an onsite provider. Behavioral health services in settings other than hosted sites should be deemed clinically appropriate by the behavioral health provider. Patients with acute psychiatric and SUD needs may not be candidates for telemedicine and must be carefully screened by the provider to determine clinical appropriateness. 

Virtual service billing

Refer to the medical policy for most coding information. These links will take you to service-specific pages.

• Mental health outpatient codes
• Care management codes
• Phone and e-visit codes
• Virtual monitoring codes