BCBSMT Modifies Telemedicine Coverage and Cost Sharing in Response to COVID-19

Apr. 17, 2020

Updated May 18, 2020

Updated July 2, 2020

Updated Aug 10, 2020

Updated Sept 10, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) is responding to the coronavirus (COVID-19) and expanding our coverage for medically necessary, covered medical and behavioral health telemedicine visits to include phone calls between providers and patients through Dec. 31, 2020. We are also giving our members access to clinically appropriate medical and behavioral health services delivered through in-network telemedicine providers with no copays or deductibles through Dec. 31, 2020 (previously Sept. 30, 2020). This will make it easier for members to access care while reducing their risk of exposure.

The cost-share waiver applies to all fully insured members whose benefit plan includes telemedicine. It applies to claims with dates of service February 4, 2020, through Dec. 31, 2020 (previously Sept. 30, 2020).

Note: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may be responsible for copay or deductibles, based on their employer’s election to participate in this benefit.

Who can provide telemedicine?

Health care providers who offer the service through two-way, live interactive telephone and/or digital video consultations may provide medically necessary, covered telemedicine services, based on state statutes.

What services can I deliver through telemedicine?

In addition to the current telemedicine services that are allowed by Montana statute, the following telephonic codes will be accepted by BCBSMT for medically necessary, covered services provided by licensed health care professionals, including behavioral health therapy services, until Dec. 31, 2020 (previously Aug. 31, 2020), and may be extended further based on the status of the COVID-19 crisis.


Code

Description

99441

Physician /Qualified Health Professional telephone evaluation 5-10 min

99442

Physician /Qualified Health Professional telephone evaluation 11-20 min

99443

Physician/Qualified Health Professional telephone evaluation 21-30 min

98966

Nonphysician telephone assessment 5-10 min

98967

Nonphysician telephone assessment 11-20 min

98968

Nonphysician telephone assessment 21-30 min


Note: This list is not inclusive of all telemedicine codes. Other services may be eligible for telemedicine reimbursement when billed with the appropriate CPT®/HCPCS codes and any applicable modifiers.

Resources:

BCBSMT Provider Portal:

  • Coding & Compensation Policies
    • Non-Physician Compensation Policy
    • Telemedicine Compensation Policy
    • Modifier Compensation and Reference Policy

Because this is a rapidly evolving situation, continue to use Centers for Disease Control guidance  on COVID-19, as the CDC has the most up-to-date information and recommendations. In addition, watch for updates on BCBSMT News and Updates.

If you have any questions or if you need additional information, please contact BCBSMT Network Management PDF Document.

As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if benefit prior authorization is required for a member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSMT’s provider website.

Please note that checking eligibility and benefits, and/or the fact that a service or treatment has been prior authorized or predetermined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member’s ID card.