Effective for dates of service on and after January 1, 2015, Highmark will reimburse mental health providers for outpatient care delivery via Virtual Behavioral Health. Please see Highmark’s Provider Manual Chapter 2, Unit 5 for more information regarding the services that may be provided through this modality and other guidelines.
What telehealth options does Highmark offer?
Virtual Visits - Services provided by Highmark in-network providers within the scote of their license, deemed appropriate using their medical judgement and delivered within the definition of the code billed.
Telemedicine - Services provided by Highmark-approved telemedicine vendors – American Well (Amwell)™, Doctor On Demand™, and Teladoc™. These approved vendors provide access to a national network of board-certified physicians with twenty-four hour, seven days a week availability.
*Note: In-network providers do not need to utilize these vendor services to provide telehealth services to Highmark members. These vendors are a separate option and benefit to certain members.
Does Highmark contract with any condition-specific virtual providers?
Yes, in efforts to increase access to Behavioral Health treatment, Highmark has contracted with several providers that offer a comprehensive virtual treatment for specific behavioral health conditions. Click on the link to view more information on how each program works and how to make a referral.
Freespira offers a digital therapeutic approach to significantly reduce or eliminate symptoms of panic attacks and PTSD in 28 days. This approach trains users to normalize respiratory irregularities by addressing CO2 hypersensitivity, an important underlying physiological factor in panic attacks, Panic Disorder and PTSD.
- Available to Commerical and ACA members in Delaware, Pennsylvania, and West Virginia who are 18 years or older and have symptoms of Panic Disorder or Post Traumatic Stress Disorder (PTSD).
Joon Care provides virtual mental health therapy for teens and young adults ages 13-24 by providing convenient, scheduled therapy with a qualified and vetted professional as well as interactive tools and on-demand resources that support skill building and individual well being.
- Available to Commercial and ACA members in Pennsylvania who are 13-24 years of age.
Meru Health provides immediate access to mental health for depression, anxiety and burnout using an integrated, mind/body approach to guide patients step-by-step towards better and long-lasting health.
- Available to Commercial and ACA members in Delaware, Pennsylvania, and West Virginia who are 18 years or older.
NOCD delivers virtual face to face therapy for patients with Obsessive Compulsive Disorder (OCD) with specialized therapists who are trained in Exposure and Response Prevention Therapy (ERP).
- Available to Commercial and ACA members in Delaware, Pennsylvania, and West Virginia who are 5 years or older.
Ria Health uses medications, online counseling, support and technologies to help members cut back or quit drinking alcohol from the comfort of their homes via telehealth.
- Available to Commercial, ACA, and Medicare members in Delaware, Pennsylvania, and West Virginia who are 18 years or older.
What services can be offered via virtual visits?
Please see Highmark’s Provider Manual, Chapter 2, Unit 5 for more information regarding the services that may be provided through this modality and other guidelines.
*Medicare Advantage NOTE: Highmark Medicare Advantage plans continue to follow The Centers for Medicaid and Medicare Services (CMS)’s guidelines for telemedicine visit coverage and reimbursement. Only the codes identified by CMS as appropriate for telemedicine services will be reimbursed by Highmark for Medicare Advantage members.
What telehealth codes are reimbursable by Highmark?
Highmark will continue to reimburse providers for virtual visits at parity with face-to-face services if the services:
- Are eligible for separate reimbursement
- Are part of the member's benefit
- Can be fully (meets the definition of the code), safely and effectively delivered through a virtual option
- Are not specifically disallowed by a Highmark medical or reimbursement policy
The use of place of service 02 (Telehealth Provided Other Than in Patient's Home) or 10 (Telehealth Provided in Patient's Home) for 1500 claims when billing for virtual health services is still required along with the appropriate use of modifier 95 on the applicable claim lines.
*Medicare Advantage NOTE: Highmark Medicare Advantage plans continue to follow CMS’s guidelines for telemedicine visit coverage and reimbursement. Only the codes identified by CMS as appropriate for telemedicine services will be reimbursed by Highmark for Medicare Advantage members.
For more information on billing and reimbursement for commercial and Medicare Advantage products, please see Highmark Reimbursement Policy Bulletin RP-046: Telemedicine and Telehealth Services.
Last updated on 9/6/2023 11:21:57 AM