Sep. 30, 2020
TELEMEDICINE – FUTURE STATE
In response to the COVID-19 pandemic, Blue Cross and Blue Shield of Montana (BCBSMT) expanded access to telemedicine services to give our members greater access to care. Moving into 2021 as the COVID-19 accommodations expire, telemedicine will continue to be a standard offering for our members. Members will be able to access their medically necessary, covered benefits through providers who deliver services through telemedicine.
Cost-share waiver ending
We also waived all cost share associated with telemedicine visits during the COVID-19 crisis. The cost-share waiver will end on Dec. 31, 2020. Starting Jan. 1, 2021, copays, deductibles and coinsurance will be applicable to telemedicine visits.
The cost share varies according to the member’s benefit plans. Some telemedicine care may require referrals and prior authorizations in accordance with the member’s benefit plan. Check eligibility and benefits for each member for details.
The cost share waiver for Medicare Advantage and Medicare Supplement members will end on Dec. 31, 2020. Starting Jan. 1, 2021, copays, deductibles and coinsurance will be applicable to telemedicine visits.
What is covered?
Coverage is based on the terms of the member’s benefit plan and applicable law. Starting Jan. 1, 2021, we will cover telemedicine codes consistent with the code lists from:
This does not include CMS’ list of telehealth services for the public health emergency.
In accordance with state statute, we will also cover the following codes:
- Physical therapy
Our self-funded employer group customers make decisions for their employee benefit plans. Check eligibility and benefits for any variations in member benefit plans.
CMS identifies covered services for Medicare members.
We recommend the following:
- Consider telemedicine a mode of care delivery to be used when it can reasonably provide equivalent outcomes as face-to-face visits.
- Choose telemedicine when it enhances the continuity of care and care integration if you have an established patient-provider relationship with members.
- Integrate telemedicine records into electronic medical record systems to enhance continuity of care, maintain robust clinical documentation and improve patient outcomes.
Providers can use telemedicine for members with the following benefit plans:
- State-regulated fully insured HMO and PPO plans
- Blue Cross Medicare Advantage (excluding Part D) and Medicare Supplement
- Self-insured employer group plans
We will continue to follow applicable state and federal requirements.
Medicare and Medicaid
Telemedicine benefits for our Medicare Advantage and Medicare Supplement members will continue until CMS directs.
We will follow the applicable guidelines of the Centers for Medicare & Medicaid Services as appropriate for Medicare Advantage and Medicare Supplement members.
Providers of telemedicine may include, but are not necessarily limited to:
- Physician assistants
- Advanced Practice Registered Nurses (APRNs)
- Licensed behavioral health
Available telemedicine visits with BCBSMT providers include:
- 2-way, live interactive telephone communication and real time audio and video consultations
- Asynchronous telecommunication via image and video not provided in real-time (a service is recorded as video or captured as an image; the provider evaluates it later).
- Other methods allowed by state and federal laws, which can allow members to connect with providers while reducing the risk of exposure to contagious viruses or further illness
Providers can find the latest guidance on acceptable HIPAA-compliant remote technologies issued by the U.S. Department of Health and Human Services’ Office for Civil Rights in Action.
Submit claims for medically necessary services delivered via telemedicine with the appropriate modifiers (95, GT, GQ) and Place of Service (POS) 02 or POS that would have been billed had the services been delivered face to face.
Note: If a claim is submitted using a telemedicine code, the modifier 95 is not necessary. Only codes that are not traditional telemedicine codes require the modifier.
Member benefit and eligibility assistance
Check eligibility and benefits for each member at every visit prior to rendering services. Providers may:
- Verify general coverage by submitting an electronic 270 transaction through Availity® or your preferred vendor.
- Connect with a Customer Advocate to check eligibility and telemedicine benefits by calling the number on the back of the member’s ID card.
BCBSMT Provider Portal:
- Coding & Compensation Policies
- Non-Physician Compensation Policy
- Telemedicine Compensation Policy
- Modifier Compensation and Reference Policy
Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association