A Guide to Providing Treatment Via Telehealth for PTs and PTAs in Washington

Telehealth law in Washington state:
  • It’s legal for PTs and PTAs to provide care via telehealth.
  • Additional law requires insurers falling under the purview of the Office of the Insurance Commissioner to pay for care when provided via telehealth if they pay for in-person treatment, unless the subscriber's health plan excludes telehealth.
  • Beginning on January 1, 2021, insurers will have to pay the same amount (parity) for treatment provided by telehealth as they would for the same treatment provided in person.
  • SB 6061, which passed during the 2020 legislative session, will require training for any provider using telehealth. This law takes effect on January 1, 2021. Nov. 18 update: We have just learned that the telehealth collaborative will post the required training during the first week in December. The current training on their website doesn't meet the requirements of the law. 
  • See additional laws below.
APTA Telehealth Courses

APTA Telehealth Resources including a template letter to use advocate for telehealth payment from payers.

Telehealth parity proclamation 20-29 extended to December 31, 2020! On January 1, 2021, SB 5385 will become effective and require parity payment for care delivered via telehealth.

Payment and Codes

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  • Payers and updates will be added when we receive notices from APTA or in writing/via website from payers. Other payers may be paying for telehealth that are not listed here. This information is correct to the best of our ability.
  • Payers have relaxed many requirements regarding their telehealth policies during the pandemic.
  • While most payers have established deadlines for these temporary policies, they have also been extending deadlines and might continue to follow the temporary policies even if the stated timeline expires. As a result, we are not currently listing these deadlines below.
APTA detailed commercial payer telehealth and e-visit guide - updated regularly

Aetna
  • Aetna will pay for physical therapy provided via telehealth during the COVID-19 crisis. (per APTA on April 2)
  • Accepted CPT codes: 97161, 97162, 97163, 97164, 97110, 97112, 97116, 97535, 97755, 97760, and 97761
  • Modifier: GT
  • Location code: 02
  • The Aetna telemedicine policy is available to providers on the NaviNet and Availity portals.

Anthem
  • AIM announced in an email that Anthem will pay for telehealth and waive member cost sharing for 90 days beginning on March 17, 2020.
  • Accepted CPT codes: 97161, 97162, 97163, 97164, 97110m 97112, 97530, 97535
  • Modifier: 95 or GT
  • Locational code: 02
  • No web link available yet.

Cigna
  • Cigna announced it will pay for physical therapy provided via telehealth during the COVID-19 crisis (per a March 30 email to providers).
  • Accepted CPT codes: any codes that are in current fee schedule that are also covered by CMS
  • Modifier: GT, 95, or GQ
  • Locational code: 11
  • UB-04 claim form: bill as normal with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier
  • Find billing and and other information here.

First Choice
Humana

Lifewise
Medicaid
Medicare (CMS)
  1. Codes: G2061=5-10 mins; G2062=11-20 mins; G2063=21+ mins
  2. Location code (location of the therapist): 12 (home) and 11
  3. Modifier: CR for Part B
  4. Bill weekly: once per 7 days; can interface with the patient multiple times but bill only once per seven days; cannot have seen the patient in person within 7 days.
  5. Patient has to initiate appointment.
  6. APTA guidance/FAQ regarding providing and billing for e-visits.

Premera Blue Cross
  • Premera Blue Cross has expanded its telehealth coverage during Washington’s COVID-19 outbreak. While there are some requirements, you may provide telehealth care to patients using all HIPAA compliant platforms, as well as some non-HIPAA compliant platforms (except those that are public facing).
  • Accepted CPT codes: 
  • Modifier: 95 with G/HCPCS codes, GT with CPT codes
  • Location code: 02
  • You may submit claims beginning on March 24, 2020. Find information about how to bill Premera for claims here. And find information about Premera’s COVID-19 telehealth expansion here, which will be in effect through December 31, 2020.

Regence Blue Shield
  • Expanded its telehealth coverage during Washington’s COVID-19 state of emergency. While there are some requirements (including that the subscriber's plan must include telehealth), you may provide telehealth care to patients using all HIPAA compliant platforms, as well as some non-HIPAA compliant platforms (except those that are public facing).
  • Accepted CPT codes: 
  • Modifier: GT
  • Location code:  02
  • Find other details here.
  • This policy effective through December 31, 2020. Payment parity effective through September 30, 2020.

Regence Medicare Advantage
  • Modifier: 95
  • Location code:  11
  • Depends on individual's plan so check for each patient.
  • Find more details here. This policy effective through December 31, 2020. Payment parity effective through September 30, 2020.

Regence Uniform Medical

UnitedHealthcare, including Medicare Advantage
  • UHC announces it will pay for physical therapy provided via telehealth during the COVID-19 crisis.
  • Accepted CPT codes: 97000, 97161-97164, 97116, 97530, 97535, 97750, 97755, 97760, 97761; may only bill one code per visit. 
  • Modifier: 95
  • Location code: 02
  • UB04 form: use revenue code 780
  • Find billing and and other information here.

TRICARE
  • Accepted CPT codes:
  • Modifier:GT
  • Location code: 02

Washington Dept. of L&I

Video Chat Platforms

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Source: APTA Private Practice Section Impact magazine

*HIPAA compliance is not guaranteed by PTWA. Please investigate your platform choice(s) to determine compliance.

HIPAA compliant* video interface
  • Doxy.me (free version)
  • Google Meet (in Gsuite) with BAA
  • Zoom with a BAA
HIPAA compliant* platforms and systems
  • Anywhere.Healthcare
  • BlueJayHealth - immediate and long term telehealth tools for PTs
  • Clocktree
  • Doxy.me (upgraded accounts)
  • Phyzio
  • Self-Doc 
  • Vsee
  • Synzi
  • Theranow
  • Kareo
Non-HIPAA compliant video interface (which may only be used under relaxed restrictions due to the COVID-19 pandemic)
  • Google Chat
  • Go-to-Meeting
  • FaceTime
  • Microsoft Teams
  • Skype
  • WhatsApp
  • Zoom

The Laws in Washington State

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  • The Washington Administrative Code (WAC) 246-915-187 specifies that PTs and PTAs may legally treat patients via telehealth. The law includes a few specific details and requirements you need to follow, detailed here. This law was passed by the Washington State Board of Physical Therapy and took effect in 2011.
  • Another Washington state law, SB 5175 - which passed the legislature in 2015, requires commercial payers and Medicaid to pay for telehealth treatment if they would pay for the treatment if it was provided in person, as long as the individual plan covers telehealth.
  • In 2016, SB 6519 established the Washington State Telehealth Collaborative (WSTC) and further defined payment requirements for telehealth.
  • In 2018, SB 6399 directed the WSTC to develop a payment pilot program, as well as to make recommendations regarding training.
  • SB 6061, which passed during the 2020 legislative session, will require training for any provider using telehealth. Scroll down to Telehealth Tools on this web page to find the training developed by WSTC. This law takes effect on January 1, 2021. The law also allows providers to meet this requirement by completing an alternative telemedicine training that is similar to the WSTC’s training.
  • SB 5385, also passed in 2020, will require payment for telehealth to be equivalent to payment if the treatment was delivered in person. This will become effective in plan year 2021.

Cash Payment from Medicare Patients

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According to a representative from Noridian:
  • Medicare will not pay for PT treatment provided via telehealth so you may be able to ask the patient to pay for telehealth treatment as a non-covered service.
  • You may ask patients who might choose this option to fill out an Advance Beneficiary Notice. Use the GY modifier.
  • Then you must bill Medicare for the treatment. Medicare will deny the claim.
  • It is possible, although unlikely, that a secondary insurance might cover telehealth.
  • Then you may bill the patient for the treatment.

Miscellaneous Resources

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Washington State Telehealth Collaborative resources including an 18-minute video training.

APTA web page with telehealth resources in light of COVID-19.

Telehealth Implementation Guidebook from the Washington State Department of Social & Health Services.

PTWA Connections article about the emergence of telehealth from March 2018.