BCBSMT COVID-19 & Telemedicine Questions & Answers

Apr. 01, 2020

This page will be updated as needed. Check back for up-to-date information.
Current Update: July 2, 2020

We are continuing to evaluate the evolving state and federal legislative and regulatory landscape relating to COVID-19 and will continue to update our practices accordingly.

What coverage and member share are there for telemedicine visits?
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. We are also giving our members access to medically necessary medical and behavioral health services delivered through in-network telemedicine providers with no copays, coinsurance or deductibles through Aug. 31, 2020. This will make it easier for members to access care while reducing their risk of exposure. The expanded benefit applies to all fully insured members whose benefit plan includes telemedicine. It applies to claims with dates of service February 4, 2020, through Aug. 31, 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, coinsurance or deductibles and may have different telemedicine benefits based on their employer’s election to participate in this benefit.

Medicare
We are also giving our Medicare members access to medically necessary medical and behavioral health services delivered through in-network telemedicine providers with no copays, coinsurance or deductibles through Dec. 31, 2020.

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.

Are telephone/voice only telemedicine services covered?
In addition to the current telemedicine services that are allowed by Montana statute, the following telephonic codes are accepted by BCBSMT for medically necessary, covered services provided by licensed health care professionals, including behavioral health therapy services, until Aug. 31, 2020, and may be extended further based on the status of the COVID-19 crisis. The following compensation schedule for covered audio-only visits is effective March 11, 2020 until Aug. 31, 2020 and may be extended further based on the status of the COVID-19 crisis.

These codes and prices are:

99441  Physician /Qualified Health Professional telephone evaluation  5-10 min - $58.15*
99442  Physician /Qualified Health Professional telephone evaluation  11-20 min - $96.61*
99443  Physician/Qualified Health Professional telephone evaluation  21-30 min - $142.56*
98966  Nonphysician telephone assessment  5-10 min - $58.15*
98967  Nonphysician telephone assessment  11-20 min - $96.61*
98968  Nonphysician telephone assessment  21-30 min - $142.56*

These codes and allowances will apply to all BCBSMT commercial plans and Healthy Montana Kids (HMK). Medicare and HMK reimbursement will follow Medicare and HMK guidelines.

What codes should be billed for the COVID-19 lab test?
CMS has recently established reimbursement for COVID-19 laboratory testing, and BCBSMT will be using the same codes and allowances for in-network lab tests:

U0001  Test for SARS-CoV-2 (CDC laboratory test) - $35.91
U0002  Test for SARS-CoV-2 (non-CDC laboratory test) - $51.31
87635   Infection agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique - $51.31
U0003 - Nucleic acid, amplified probe technique for SARS-2-CoV-2, making use of high throughput technologies - $100
U0004 - Any technique, making use of high throughput technologies - $100

What COVID antibody testing can be billed?
Two new codes for antibody testing have been established effective 4/10/2020. The pricing has been established as follows:
86769 - Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) - $12.88
86328 - Immunoassay for infectious agent antibodies, qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(Coronavirus disease [COVID-19])  $18.09

Already established code 86318 ($24.42) was revised to indicate immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g. reagent strip) and may also be billed for testing for COVID antibodies.

How are telemedicine services identified on a professional claim billed on a 1500?
For Commercial and Healthy Montana Kids (HMK) claims, providers should indicate originating place of service 2 (telemedicine). Additionally, to expedite claims, BCBSMT asks providers to add modifiers GQ or GT on lines of service not identified as telemedicine within the code description.
(Example: CPT 99212 (In-Office E/M visit) performed by video/audio platform would require a GQ or GT modifier.)

For Medicare Advantage, providers should follow CMS’ current guidance for telemedicine claims.

How are telemedicine services identified on facility claim billed on a UB?
For Commercial and HMK claims, facilities should include modifier GT on lines of service not identified as telemedicine within the code description.   Revenue codes should remain consistent with the services provided and not use revenue code 078X.
(Example: CPT 97110 (PT Therapeutic Exercise) performed by video/audio platform would require a GT modifier.)

For Medicare Advantage, providers should follow CMS’ current guidance for telemedicine claims.

What codes may I bill for telemedicine?
Providers may bill for medically necessary covered services that can be performed via telemedicine.

Are telemedicine visits limited to COVID-19 diagnosis codes?
No, telemedicine visits are not limited to claims with a COVID-19 diagnosis codes.

What ICD-10 Diagnosis should be used for COVID-19 on claims?
B9729 - Other coronavirus as the cause of diseases classified elsewhere
U071- 2019-nCoV acute respiratory disease (April 1, 2020 and after)
Z03.818 - Possible exposure to COVID-19
Z20.828 - Actual exposure to COVID-19

For more information, please see this CDC release.  PDF Document

Should I use modifiers slated for catastrophe or disaster?
The National Uniform Claims Committee is now considering the use of DR and CR modifiers:

  • DR - Disaster Related - For Institutional Billing
  • CR - Catastrophe/Disaster Related - For Physician & Institutional Billing

However, these codes should not be used for telemedicine services and providers should follow CMS guidelines when using these modifiers. There is currently no claim impact for the use of modifiers DR or CR.

Can I bill for remote patient monitoring?
Yes. BCBSMT does reimburse for remote patient monitoring when covered under the member’s benefit plan. Pricing for these codes are published in our secure provider portal.

Can preventative medicine services and preventative health exams be performed via telemedicine?
Preventative medicine services and preventative health exams cannot be performed via telemedicine.

Are Applied Behavioral Analysis (ABA) services covered via telemedicine?
ABA services for the diagnosis of autism performed by licensed and Board-Certified Behavior Analysts, licensed Board-Certified Behavioral Analysts-Doctoral or Autism Treatment Agencies may perform covered medically necessary ABA services via telemedicine.

Are services for Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) services covered via telemedicine?
Licensed PT, OT, and ST providers may perform covered medically necessary therapy services via telemedicine.

Are Digital Evaluation & Management codes covered?
Yes. BCBSMT removed claim edits for codes 99421-99423 for the COVID-19 crisis. Coverage is dependent upon the patient’s benefit plan. Pricing for these codes are published in our secure provider portal.

Are services and products provided by BCBSMT being delayed due to the COVID-19 crisis?
BCBSMT has built contingency plans for this scenario. Our staff – including Customer Service, Claims Processors, Network and Sales teams and clinical staff are here to serve our providers, members and our Montana communities.

Are benefits and coverage different for Federal Employee Program (FEP)?
FEP has published guidelines for COVID19 coverage and telehealth. You can learn more here. 

What codes and services are covered for HMK (Healthy Montana Kids)?
HMK coverage notification can be found here PDF Document.

What if I have additional questions?
We’re happy to answer your questions about these topics or other concerns you may have. Our Contact Us Guide is located here PDF Document.

Additional Resources:
BCBSMT Provider Portal:

  • Coding & Compensation Policies
    • Autism Compensation Policy – Applied Behavioral Analysis (ABA)
    • 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.

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.

Codes listed in this publication are 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.

Medicare and HMK reimbursement will follow Medicare and HMK guidelines. *Non-Physician Discounts will still apply to claims, including telemedicine claims. Discounts are not applied to laboratory, x-ray, machine tests, drugs, vaccines, durable medical equipment, prosthetics, orthotics, or supplies.