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BCBS Offers Details About Telehealth During Covid 19 Pandemic

Posted by [email protected] on Mar. 31, 2020  /  Subscribe 0

BCBS COVID-19 Talking Points Regarding Telehealth

NEWLY UPDATED (As of 3/31/2020)

Q: Will BlueCross cover telehealth (telephonic or virtual) consultations with my patients with BlueCross coverage?

Yes. During this time of emergency, you may bill for telehealth for Commercial and Medicare Advantage lines of business. This applies to services that previously required an in-person visit in settings like outpatient clinics, hospitals and emergency departments. Pricing will be consistent with your BlueCross fee schedule if all of the following conditions are met:

• The services provided are covered under the member’s benefits, and are eligible for separate payment when performed in person.
• The services take place in real time, and the provider and patient are connected via an interactive audio and video telecommunications system.
• All services provided are medically appropriate and necessary.
• All relevant online communications about the member’s medical care and follow-up are included in their medical record.
• Any evaluation and management services (E/M) provided via telehealth include a problem-focused history and straightforward medical decision making, per the Current Procedural Terminology (CPT®) manual.
• When billing for telehealth, applicable service codes, diagnostic codes, modifiers and units should be reported with Place of Service-02 to indicate a telehealth service.

Q: Are there any telehealth services that BlueCross will not cover?

We won’t cover telehealth for educational or administrative services. We also won’t cover patient communications incidental to evaluation and management services (E/M), counseling or medical services covered by this policy. This includes, but is not limited to, providing educational materials.

Please note: For questions about BlueCare and telehealth, please see below.

Q: Will BlueCare cover telehealth (telephonic or virtual) consultations with my patients with BlueCare coverage?

Yes. During this time of emergency, you may bill for telehealth in the following ways:

• CPT® codes 99441 – 99443 for telephonic provider-to-member consultations for all lines of business’ PCP or specialist benefits.
• E&M codes 99201–99215 for virtual and telephonic consults with your patients.
• CPT® codes 97153, 97155, and 97156 , 90791, 90792, 90832, 90834 and 90837 for behavioral health consultations
• CPT® H0032 and H2019 (with or without a modifier HO) for Applied Behavior Analysis (ABA) therapy.

BlueCare Telehealth Guidelines for Skilled Therapies:  

 Specific outpatient PT/OT/ST CPT® codes are included as part of the temporary expansion of telehealth services as a result of the COVID-19 public health emergency.

• Effective for dates of service March 18 through June 18, 2020
• Providers supported by this exception are licensed physical therapists, occupational therapists and speech-language pathologists.
• All services provided are medically appropriate and necessary.
• The services must take place in real time, and the patient and provider are connected via an interactive audio and video telecommunications system.
• All relevant online communications about the member’s medical care and follow-up are included in their medical record.
• Any existing visit limitations and/or prior authorization requirements continue to apply .
• When billing for telehealth, applicable service codes, diagnostic codes, modifiers and units should be reported with Place of Service-02 to indicate a telehealth service.

Excluded from this temporary expansion of Telehealth services:

• Any treatment that requires specialized hands on care or specialized equipment, such as whirlpools, etc.  This includes Athletic Trainings (97169 – 97172), Modalities (97010 – 97039) and Group Therapies.  Any member currently receiving group therapy should be considered for individual therapy via telehealth.

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