Important COVID-19 Update: Use of Telehealth

During the COVID-19 crisis, many funding sources are authorizing telehealth services in order to curtail the spread of the virus and minimize disruption to medically necessary treatment. ABABCC has collected information from funding sources throughout the US on telehealth options for delivery of ABA-based services.
This resource does not substitute provider due diligence in ensuring any given funding source will reimburse for services via telehealth. To ensure reimbursement, providers should contact funding sources, secure authorization, and follow provider guidelines.

Behavior Analysis in Practice Emergency Publication Series:

Britwum, K., Catrone, R., Smith, G. D., & Koch, D. S. (2020, May 5). A University Based Social Services Parent Training Model: A Telehealth Adaptation During the COVID-19 Pandemic. https://doi.org/10.31234/osf.io/gw3cd

Higbee, T. (2020, April 17). Mattson, Higbee, Aguilar, Nichols, Campbell, Nix, Reinert, Peck, and Lewis-Digital Materials Tutorial BAP. https://doi.org/10.31234/osf.io/9gwpj

Colombo, R., Wallace, M., & Taylor, R. S. (2020, April 11). An Essential Service Decision Model for Applied Behavior Analytic Providers During Crisis. https://doi.org/10.31234/osf.io/te8ha

Tarbox, C., Silverman, E. A., Chastain, A. N., Little, A., Bermudez, T. L., & Tarbox, J. (2020, April 30). Taking ACTion: 18 Simple Strategies for Supporting Children with Autism During the COVID-19 Pandemic. https://doi.org/10.31234/osf.io/96whj

Yi, Z., & Dixon, M. R. (2020, April 23). Developing and Enhancing Adherence to a Telehealth ABA Parent Training Curriculum for Caregivers of Children with Autism. https://doi.org/10.31234/osf.io/sc7br

Kornack, J., Williams, A. L., Johnson, K. A., & Mendes, E. M. (2020, May 8). Reopening the Doors to Center-Based ABA Services: Clinical and Safety Protocols during COVID-19. https://doi.org/10.31234/osf.io/ctxkf

LeBlanc, L., Pearson, J. L., Pollard, J., & Unumb, L. S. (2020, May 13). The Role of Compassion and Ethics in Decision-Making Regarding Access to Applied Behavior Analysis Services During the COVID-19 Crisis: A Response to Cox, Plavnick &Brodhead. https://doi.org/10.31234/osf.io/ma23n

Zoder-Martell, K., Markelz, A., Floress, M. T., Skriba, H. A., & Sayyah, L. E. N. (2020, May 6). Technology to Facilitate Telehealth in Applied Behavior Analysis. https://doi.org/10.31234/osf.io/nz5s7

Rodriguez, K. (2020, March 30). Maintaining Treatment Integrity in the Face of Crisis: A Treatment Selection Model for Transitioning Direct ABA Services to Telehealth. https://doi.org/10.31234/osf.io/phtgv

Cox, D. J., Plavnick, J., & Brodhead, M. T. (2020, March 31). A Proposed Process for Risk Mitigation During the COVID-19 Pandemic. https://doi.org/10.31234/osf.io/buetn

Szabo, T., Richling, S., Embry, D. D., Biglan, A., & Wilson, K. G. (2020, April 3). From Helpless to Hero: Promoting Values-Based Behavior and Positive Family Interaction in the Midst of Covid-19. https://doi.org/10.31234/osf.io/sgh5q

Fronapfel, B. H., & Demchak, M. (2020, April 12). School’s Out for COVID-19: 50 Ways BCBA Trainees in Special Education Settings Can Accrue Independent Fieldwork Experience Hours During the Pandemic. https://doi.org/10.31234/osf.io/cr3uv

Please note: This information is subject to change and does not supersede information received from payor representatives. Where published guidance is not publicly available, ABABCC urges providers to seek written confirmation that telehealth for ABA is permitted, not only by funding sources but for individual patients. Some health plans do not include a telehealth benefit, and no industry-wide guidance has yet been provided to address the gap in those plans.

Billing: To bill for telehealth, most funding sources use the GT modifier and 02 for place of service. (Providers should verify with each funding source.)

Cost-Sharing: Cost-sharing for telehealth services may be different from cost-sharing for in-person services and/or during the COVID-19 crisis. ABABCC urges providers to confirm cost-sharing policies with each funding source.

Billing Codes: Many funding sources are authorizing all codes for telehealth, denoted in the table below with an asterisk. Some funding sources have limited telehealth to family guidance/parent training and/or activities of the behavior analyst (assessment; protocol modification; direction of the clinician). Providers should continue to get patient-specific confirmation regarding the use of telehealth. Many of the telehealth authorizations are tied to the federal declaration of emergency. You can find the most recent emergency declaration here.

State Laws: Some states have additional requirements for providers delivering telehealth, such as informing patients they have a right to seek in-person services. Providers are advised to ensure they are in compliance with state laws. The Center for Connected Health Policy may be a helpful resource.

Licensure Laws: In states where behavior analysts are required to be licensed, telehealth may be provided only by licensed providers. For example, a provider in California may not deliver telehealth services to a patient in Texas unless that California provider has the Texas license.

HIPAA-Compliant Telehealth Platforms: Some funding sources require providers to confirm and/or submit an attestation confirming telehealth platforms are secure and HIPAA compliant, so it is imperative that providers contact funding source representatives to ensure all proper paperwork has been completed. Update: On March 17, the Office for Civil Rights at the U.S. Department of Health and Human Services announced that, pertaining to telehealth, HIPAA will not be enforced during the COVID-19 response.

Funding Sources Authorizing Telehealth—Updated 7/29/2020

ALL INFORMATION SUBJECT TO CHANGE. PLEASE READ ABOVE GUIDANCE.

PROVIDERS SHOULD CONFIRM TELEHEALTH COVERAGE FOR EACH INDIVIDUAL PATIENT.
SUBMIT CORRECTIONS OR UPDATES TO MAIL@ABABILLINGCODES.COM

Note: Many of the telehealth authorizations are tied to the federal declaration of emergency. You can find the most recent emergency declaration here.

  • Cigna*
  • Colorado Medicaid*
  • Community Behavioral Health
  • Community Care Plan FL
  • Community Health Group*
  • ComPsych*
  • Confluence Health*
  • Contra Costa*
  • CT – CMAP*
  • DC Medicaid – HSCSN
  • Dean Health Plan*
  • Empire BCBS NY*
  • Excellus BCBS*
  • Exclusive Care*
  • FL Medicaid
  • ForwardHealth*
  • GA Medicaid
  • Gold Coast Health Plan*
  • Golden Rule
  • Harvard Pilgrim*
  • Health Alliance
  • HealthNet MHN*
  • HealthNet MHN Medicaid*
  • Health Partners*
  • Health Plan of Nevada*
  • Health Plans, Inc.*
  • HealthScope*
  • HealthShare OR*
  • Healthy Blue Medicaid Louisiana*
  • Highmark Blue Cross PA
  • Holman Group*
  • Horizon BCBS NJ*
  • HSCSN – DC Medicaid
  • Humana* (NOT TRICARE)
  • Humana Louisiana*
  • Inland Empire Health Plan*
  • InterCommunity Health Network CCO*
  • Kaiser Hawaii*
  • Kaiser MAS*
  • Kaiser So Cal
  • Kern Health Systems*
  • Louisiana Medicaid*
  • Louisiana Healthcare Connections*
  • Macomb County (MI Medicaid)*
  • Magellan*
  • Magellan Complete Care of VA*
  • Maryland Medicaid
  • MassHealth*
  • MBHC (MA)*
  • Medi-Cal*
  • Mental Health Consultants*
  • MHN*
  • Michigan Medicaid*
  • Minnesota Medicaid*
  • Moda Health*
  • Molina Medi-Cal*
  • Molina Louisiana Medicaid*
  • Molina New Mexico*
  • Molina WA Medicaid*
  • Montcalm* (MI Medicaid)
  • MultiPlan*
  • Nebraska Medicaid
  • Network 180* (MI Medicaid)
  • New Directions
  • New Hampshire Medicaid*
  • New Mexico Medicaid
  • Optima*
  • Optum Maryland Medicaid*
  • Optum/UBH*
  • OR Health Authority*
  • OR Medicaid DMAP*
  • Ottawa (MI Medicaid)*
  • PacificSource*
  • Partnership Health Plan (CA Medi-Cal)*
  • Premera Blue Cross WA*
  • Priority Health Michigan
  • Regence Blue Shield OR*
  • Regence Blue Shield WA*
  • Santa Clara Family Health Plan*
  • Sierra Health & Life
  • Spring Tide Health
  • TRICARE
  • Trillium* (OR Medicaid)
  • Tufts*
  • UBH MA Health*
  • UBH Medi-Cal*
  • UBH/Optum*
  • UBH Washington Medicaid*
  • Umpqua Health*
  • UnitedHealthcare Community Plan AZ*
  • UPMC*
  • US Family Health
  • Valley Health Plan*
  • VA Medallion 4.0*
  • WA Medicaid*
  • Wisconsin Medicaid*
  • Yamhill Community Care – OR Medicaid*

*All codes authorized for telehealth