Well Visits During COVID-19 – Telehealth Options

Summer 2020

As the COVID-19 pandemic evolves, Neighborhood has been staying abreast of all confirmed developments related to the spread of the virus and will continue to be vigilant in efforts to develop and share information and guidance.

Telehealth has quickly become an important tool in caring for members while keeping yourself and your staff safe. We know these are challenging times and we are committed to supporting you in your provision of well-care services to our members.

What Neighborhood Is Doing to Help

  • Distributing Provider Gap in Care Reports to Primary Care Offices to identify members who need a well visit.
  • Providing Member Rewards (i.e., $25 gift card for 18 months and 3-19 years) for members who had a yearly check-up. (See website below.)
  • Educating members on the importance of well visits through television; radio; social media; and Neighborhood’s website/newsletters.
  • Developed a new Temporary COVID-19 Telemedicine/Telephone-only payment policy (see website below). This new policy supports our providers in providing medically necessary and clinically appropriate care to our members.

What Providers Can Do to Help

  • Use telehealth, telephone-only, and other non-direct care, when appropriate.
  • At the end of each visit, encourage members to schedule their next appointment and annual checkups for each of their family members.
  • Inform practice staff that annual checkup visits for members 3-21 years and older can be scheduled 2-3 weeks before birthday.
  • Take advantage of every office visit (e.g., sick visits) to provide well care components when applicable.
  • Utilize Provider Gap in Care Reports provided by Neighborhood to help identify members who have not had a visit with a primary care practitioner.
  • Use codes that meet HEDIS requirements:
  • Children and Adolescent Access to Primary Care Practitioners (CAP) measures codes:
    • ICD-10: 00,Z00.01,Z00.121,Z00.129,Z00.3,Z00.5,Z00.8,Z02.0,Z02.1,Z02.2,Z02.3,Z02.4,Z02.5,Z02.6,Z02.71,Z02.79,Z02.81,Z02.82,Z02.83,Z02.89,Z02.9Z76.1,Z76.2
    • HCPCS: G0402,G0438-G0439,G0463,T1015
    • CPT: 98966-98969,99201-99205,99211-99215,99241-99245,99341-99345,99347-99350,99381-99387,99391-99397,99401-99404,99411-99412,99429,99441-99444,99483
    • UBREVENUE CODES: 0510-0517,0519-0523,0526-0529,0982-0983
[Note: Per NCQA, “A measure specification that is silent about telehealth includes telehealth.” The preceding codes with a telehealth modifier and POS meet HEDIS requirements.]
  • Telephone-Only Visits CPT codes for Children and Adult Access to Primary Care Practitioners
  • CPT: 98966-98968, 99441- 99443

Additional Resources:

Neighborhood COVID-19 Provider Guidance

Member Rewards Forms