Aetna, UnitedHealthcare, and Cigna have moved forward with face-to-face telehealth delivered by PTs during the COVID-19 pandemic. Will the innovations gain traction?

For many PTs and PTAs, it's an all-too-familiar pattern: CMS makes a rule change or payment adjustment, and sooner or later commercial insurers follow suit. But the COVID-19 pandemic is flipping that narrative, as some insurers innovate their way past CMS to increase patient access to care. One such innovation: allowing PTs and PTAs to provide telehealth services by reimbursing for real-time face-to-face modalities as well as non-real time and non-face-to-face services.

Over the past weeks, insurance giants Cigna, Aetna, and UnitedHealthcare have each announced temporary benefit changes allowing PTs to bill for most therapy codes delivered by way of telehealth. Unlike CMS, which is permitting coverage of some services furnished remotely by PTs — including e-visits, virtual check-ins, remote evaluation of recorded video or images, and telephone assessment and management services — the commercial benefit changes represent a key upgrade: They provide for reimbursement of services using interactive video that allows clinicians and patients to see and hear each other in real time, with patients performing movements that their PT or PTA can observe and adjust remotely. APTA consulted with the payers as they considered the changes.

"This is a significant moment," said Carmen Elliott, APTA's vice president of payment and practice management. "It's not just an important step in responding to the current health emergency — it's a forward-thinking shift that will help the profession show its value in the full range of telehealth once the current crisis is over."

Elliott thinks the insurers deserve credit for their willingness to innovate.

"In each instance, these payers put public health and safety first while responding to the needs of their policyholders," Elliott said. "They could've taken a wait-and-see attitude and followed the lead of CMS, but they decided to take a quicker approach."

While the three major insurers moved relatively quickly to allow for providing robust telehealth in therapy, CMS has taken a more incremental approach. In March, it announced waivers for e-visits, virtual check-ins, remote evaluation of recorded video/images, and telephone assessment and management services. However, the agency stopped short of waivers to allow PTs to deliver therapy in a synchronous, real-time face-to-face visit. More recently, the agency took another halting step forward by approving the use of many common therapy codes for telehealth — yet not including PTs, PTAs, occupational therapists, or speech-language pathologists among the providers who could use them in face-to-face provision of remote services.

"Part of the reason these commercial insurers felt they could move so quickly and decisively has to do with what they've already seen in terms of physical therapy's effectiveness in many areas, not just telehealth," said Katy Neas, APTA executive vice president of public affairs. "APTA has been working to establish collaborative relationships with insurers such as UnitedHealthcare whenever possible, and helping to educate them on physical therapy's benefits to patients and the health care system overall. We're sending the message that the physical therapy profession is a profession of innovators. Insurers are beginning to see that and take action in response."

That spirit of innovation has ramped up across the country during the COVID-19 pandemic as PTs and PTAs find ways to care for patients outside of the traditional clinic setting. It' was the subject of a recent APTA-sponsored Facebook Live event, "COVID-19: Adapting Your Practice," that brought together four PTs who have adopted fresh strategies to meet the needs of their patients. A recording of the event is available.

Elliott says that the insurers have been taking steps to embrace at least one element of the profession's innovative capabilities, and thinks other payers should take note.

"We hope that CMS and other payers are tuned into what's happening right now with Aetna, UnitedHealthcare, and Cigna," Elliott said. "Patients are getting access to the care they need without putting themselves or their therapists at risk, and PTs are showing that telehealth can be an important part of the physical therapy toolkit. We know PTs will establish a track record by providing telehealth at this critical time with the potential for positive ripple effects far into the future."

Visit APTA's Telehealth webpage for regularly updated information on payment, information on coding, and general guidance on what to consider when evaluating whether telehealth is right for you.