Telehealth visits (virtual services) allow members to receive primary, specialist or urgent care using a computer, phone and/or tablet.
All members have access to expanded telehealth (virtual services) through December 31, 2024. In addition, most members have standard telehealth benefits. (See the Standard telehealth section below.)
Telehealth services can be provided if the services:
- Are safely and effectively delivered virtually
- Meet existing coverage criteria, including pre-authorization requirements and medical necessity
- Are rendered by a provider who meets our credentialing criteria.
Learn more about our credentialing requirements for out-of-area virtual support providers.
Behavioral health: View information about the diverse range of in-network providers rendering mental health and substance use disorder (SUD) treatment on our Behavioral Health Toolkit.
Telehealth vendors: In addition to care provided by in-network providers, we contract with approved telehealth vendors to provide services to our members. The vendor must be licensed at the location where the provider and member are physically located.
To support our members, we cover expanded and standard telehealth services.
- We will provide 90 days' notice prior to discontinuation of expanded telehealth coverage. Note: Please continue to refer to the Clinical Edits by Code List and our member’s benefits for non-covered services. Verify member’s benefits using Availity Essentials.
- See specific dates of service below for reimbursement guidelines.
Risk adjustment
CMS has indicated that providers can include diagnosis codes on telehealth claims for risk adjustment purposes. For risk adjustment, telehealth visits must be conducted using audio and video.
If captured using audio and video, member reported blood pressure readings will count toward gap closures and be included in risk adjustment.
As with face-to-face visits, diagnosis codes included on claims must have sufficient documentation and may be subject to review. Refer to the Risk Adjustment section of our website for additional information about documentation requirements.
Palliative care
As a participating provider, you can conduct advance care planning (ACP) conversations with your patients via telehealth.
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