Some employers are self-funded, which means they make the decisions as to what benefits are offered on their plan. A few self-funded employer group plans do not provide coverage for or have limited telehealth benefits. Now that the health care systems have adapted and are able to serve more patients in-office, some of these self-funded plans are returning to our standard telehealth benefits. After Aug. 31, 2020, providers are encouraged to log into the Provider portal to check members' benefits prior to delivering telehealth services.

Telehealth Payment Parity

Wellmark will extend payment parity for appropriate medical and behavioral health virtual visits with an in-network provider in Iowa and in South Dakota until further notice.

Virtual Visit Billing – Updated 7/20/21

As providers are aware, the telehealth provisions in the Iowa Governor’s COVID-19 Public Health Disaster Proclamation expired on June 30, 2021, which had included both coverage for audio-only telehealth and waiver of professional scope of practice limitations on audio-only telehealth. Providers are responsible for knowing and complying with their own professional scope of practice. For providers whose ordinary professional scope of practice does not prevent audio-only telehealth services, such providers may continue billing telephonic (audio-only) visits in accordance with COVID-19 billing guidance using the same codes they would use if the services were provided in person and place of service “02” on a transitional basis until September 1, 2021. Effective September 1, 2021, Wellmark will no longer allow telephonic (audio-only) visits for telehealth services for any provider, and all providers will be required to comply with Wellmark’s Provider Guide for billing services performed by telehealth.

Refer to the “Payment Policies and Reports” section of the Wellmark Provider Guide found on Wellmark.com (Provider > Communications and Resources > Provider Guide) for billing services performed by telehealth.

**This update is for telephonic (audio-only) only telehealth and does not impact payment parity.

Medically Appropriate codes for virtual visits

Based on input from physicians and other clinicians in our two states, Wellmark has established the following list of services that can be performed via a virtual visit (telehealth) and will be paid at the in-office fee through Oct. 31:

Medical or Office Visits

Behavioral Health Services

Therapeutic Services

Other codes will be evaluated if the need arises.