OSP News

Priority Health’s Telemedicine / Virtual Services Billing Updates

Posted: 01/13/2025

Priority Health, aligns their telehealth / virtual services billing guidelines with the American Medical Association (AMA), the Centers for Medicare and Medicaid (CMS) and the Michigan Department of Health and Human Services (MDHHS). AMA and CMS recently released updates effective January 1, 2025 – please see below how these updates apply to Priority Health’s plans:

New CPT telehealth codes for commercial plans

AMA introduced new telehealth-specific codes (98000-98016) effective January 1, 2025. They’ll cover these codes for their commercial plans, in addition to the regular evaluation and management (E/M) codes.

The new codes are outlined in Priority Health’s medical policy #91604 – Telemedicine / Virtual Services. Continue to follow the billing guidance available in the Provider Manual.

Note: Medicare doesn’t recognize these new codes, and so Priority Health isn’t covering them for their Medicare plans. Additionally, Medicaid hasn’t yet issued a 2025 fee schedule – they’ll  continue to follow Medicaid’s guidelines as they’re released.

Extension to PHE telehealth flexibilities

Congress extended the COVID-19 public health emergency (PHE) telehealth flexibilities that were in place for Medicare plans through Mar. 2025. Priority Health will apply this extension to their Medicare plans as well.  

These flexibilities loosened geographic and location restrictions on where services could be provided, and loosened limitations on the scope of practitioners who can provide telehealth services. See CMS’s MLN Matters article MM13887 for more details.

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