VSP Vision Care Telehealth Information

Did you know? Approximately 60% of VSP Vision Care members have VSP Primary EyeCare Plan^SM or the VSP Diabetic Eyecare Plus Program^SM coverage that can be delivered via telehealth channels. This includes specific Evaluation and Management CPT codes (99201-99205, 99211-99215) and 92227 and 92228 (remote retinal imaging services) covered under the Primary EyeCare Plan and Diabetic Eyecare Plus Program, with appropriate modifiers to indicate the modality it was rendered (95 synchronous/QT asynchronous).

These codes allow providers to treat a patient without face-to-face interaction for medical issues, such as conjunctivitis under Primary EyeCare. Evaluation and Management services are paid the same for in-person and via telehealth channels. A list of covered medical eye care services that can be billed remotely can be found here.

• If evaluation and management services are performed remotely or you provide remote retinal imaging services, bill the CPT code with a GQ or 95 modifier, as appropriate.
• Use code 11 - Office as the Place of Service (POS code 11) Note: VSP does not currently support Place of Service (POS) code 02 for reporting telehealth services rendered from a distant site. Instead, we require Modifiers GQ or 95 to identify telehealth services, as appropriate.
• Technology and equipment used is up to the sole discretion of the provider, same as today for in-person equipment.
• Remember, the VSP Primary EyeCare Plan and Diabetic Eyecare Plus Program are supplemental to a patient’s health plan coverage. Standard coordination of benefit guidelines apply.
• New legislation allows optometric physicians the flexibility and recognition to treat patients remotely for certain eye care needs. Be sure to follow regulations/licensing requirements as directed by your state.

For more information regarding telehealth services covered under the VSP Primary EyeCare Plan and VSP Diabetic Eyecare Plus Program Plan, refer to the Provider Reference Manual on VSPOnline at eyefinity.com.