Guidance on the use of telehealth in the District of Columbia memo.

DC Health has waived the licensure requirements for healthcare practitioners who hold a license in good standing in another jurisdiction, so long as that practitioner is (1) working at a licensed DC healthcare facility, or (2) is providing continuity of healthcare services to existing patients who are returning to the District.

Advisory: Providers and Patients Pay Attention to Requirements When Billing Insurers for Services Delivered via Telehealth: For telehealth-based claims that have been rejected, even though the insurer says they’ll reimburse for services delivered remotely. Often the reason for the denial is clear: The provider omitted coding and other information required by the insurer, or used a code for a specific service that the insurer isn’t accepting as billable in the first place.

One of the more common reasons for the denials we’re seeing has to do with code 97530 — therapeutic activities. Many payers— including insurance giants Aetna and Cigna—do not include 97530 among the codes that can be billed when delivered via telehealth. PTs who use this code as part of telehealth billing will have their claims denied.

Many of the insurers allowing telehealth have rules on which codes can be used, what place of service must be identified, and what modifiers should be added. APTA offers an online resource, updated weekly, that can help you stay on top of the requirements. And be sure to check the payers’ websites, too.

Recommended Resources

Different Telehealth Modalities and PTs’ and PTA’s Eligibility to Use Them
Includes descriptions of live video, e-visits, virtual check-ins, remote evaluation of visual recordings, and telephone assessment and management services.

Billing and Coding Considerations
Includes basic information and recommendations on billing and coding for physical therapist services provided via telehealth.

Implementing Telehealth in Your Practice
Before adopting any telehealth solution, investigate issues such as eligibility under your state’s practice act, legal and privacy considerations, payer policies, and liability; and review practical considerations for when you begin using telehealth services.

Thinking About Providing Telehealth? Here’s Our Top 10 ‘To-Do’ List
Step 1 is knowing what’s allowed, and what isn’t. (March 27, 2020)

Advocate for Coverage

Template Letter to Advocate for Coverage of Telehealth with Commercial Payers
If telehealth is not included as a covered service in your contracts with commercial payers, you can use this letter which includes talking points and research.

Help get telehealth covered through CMS. We have developed a template letter you can send to your legislators (word doc) asking them to cosponsor these bills.

APTA also has compiled research studies on telehealth (.pdf) and testimonials from APTA members on how they have balanced in-person and telehealth visits.