Hi everyone. We want to share some information about how we bill for care at Needham Pediatrics, specifically regarding some changes that have arisen during the COVID pandemic.
During the COVID-19 pandemic, we quickly rolled out Telehealth capability, allowing many of our patients to get care remotely if they are unable to come into the office or feel safer being treated remotely. There are two types of telehealth visits: (1) videoconferencing encounters, and (2) audio-only encounters.
We bill both types of telehealth visits to your insurer, just as we would for an in-person visit. During the COVID-19 pandemic, because of a mandate from Governor Baker, insurers have significantly expanded their coverage of telehealth services. In most cases, your insurer will provide coverage for these visits in the same manner that they cover in-office visits. Telehealth encounters may be subject to co-payments or may be applied to your deductible, depending on your insurance plan.
Not all insurers are treating Telehealth visits in the same manner. If you are unsure about the specifics of your coverage for these visits, we suggest you contact your insurer. You are also free to contact our Billing team if you have questions regarding a bill you received from us.
Patients who need COVID tests can have the tests done at Needham Pediatrics. Symptomatic patients or asymptomatic patients with an exposure will typically be given an appointment with our doctors or nurse practitioner for a clinical evaluation and for testing, if indicated. These visits will be billed with an "evaluation and management" or E/M code, as is standard for any "sick visit" in our office.
Asymptomatic patients without an exposure can have a COVID test done via a nurse visit, without needing to be seen by one of our providers. This type of visit is appropriate for asymptomatic patients who need testing because of travel, school, or an extracurricular activity.
Nurse visits for COVID testing will generate a billing charge from us. For these visits, we use a specific nurse-only billing code (E/M code of 99211). This charge is meant to cover our office costs associated with staff time, utilization of personal protective equipment (PPE), testing supplies, and cleaning of examination rooms before and after your visit. In most cases your insurance will cover this charge, but depending on your insurance plan, deductibles or co-pays may apply. If you are unsure about the specifics of your insurance coverage, you should contact your insurer.
Currently, we send all our swabs for COVID-19 testing to either BID-Needham or Quest Laboratories. The labs will also generate a charge for performing the COVID test, separate from our office charge. In most cases, your insurance will cover this charge; again, co-pays and deductibles may apply.
Please feel free to contact us if you have any questions.