August 2024
As a reminder, we cover telemedicine routine vision exams consistent with an in-person exam when those telemedicine exams meet our expectations and requirements as listed in the Clinical Practice guidelines section of the Provider Reference Guide.
You must use your professional judgment to determine whether telemedicine is appropriate for a member. To submit telemedicine claims, telemedicine exams must be allowed in your state, and you must complete a Telemedicine Attestation and have it approved by us. Please reach out to your Provider Relations Advocate for instructions.
Additional credentialing may be required, including verification of licensure in states where members are located. Once approved to submit claims, use Place of Service Code 02 with the codes below on your electronic (EDI) claim, paper claim or claims submitted via the portal. Claims for materials must be filed separately with the appropriate Place of Service Code. Members must be informed in advance when exams are performed via telemedicine.
Accepted codes for telemedicine claims are: 92002, 92004, 92012, 92014, 92015, or S6020, S6021 when applicable. Our HEDIS® requirements apply to all telemedicine exam claims.
Dilated Fundus Exam (DFE): If a telemedicine exam indicates the possibility of active ocular pathology, you must refer the member for local, in-person care. Additionally, if a DFE is warranted after a telemedicine exam, the DFE must be offered within 7 days and within a reasonable distance of the telemedicine site.