CurrentBlue Cross Blue Shield - MainePolicy C-08002

Virtual Visits - Professional and Facility

Defines reimbursement rules for professional virtual visits (telehealth/telemedicine and related virtual services) provided to Anthem Blue Cross and Blue Shield - Maine members, including eligible place of service, coding guidance, and non-reimbursable virtual interactions.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyVirtual Visits - Professional and Facility

Policy CodePolicy C-08002

Change TypeNo material change

Effective DateMar 1, 2025

Next Review Date

Key ActionProviders must follow authorization and medical necessity guidelines; services may require authorization per the member's benefit plan and applicable mandates.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

POS 02 & 10telehealth office-based POS accepted

Modifiers 95/GT/GQtelehealth modifiers noted

Audio-only excludedaudio-only exclusion

RPM coveredRPM

Historical updatesrevision history

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Virtual Visits Coverage Criteria

Virtual Visits coverage criteria

Covered when ALL of the following are met:

Professional virtual visits are reimbursable when interactive services occur between the member and the provider who are not in the same location, unless provider, state, or federal contracts and/or mandates indicate otherwise.

Virtual visits rendered by professional providers must be delivered through a secure, private connection.

Professional virtual visits billed by a professional provider are eligible for office place of service reimbursement.

Claims must include the appropriate CPT/HCPCS code and the applicable telehealth/telemedicine modifier as indicated in Related Coding.

Place of service for synchronous audio‑visual visits: use POS '02' or '10' as applicable; for Remote Patient Monitoring use the place of service appropriate to the location of the billing provider.

Remote Patient Monitoring is reimbursed when billed with the appropriate CPT/HCPCS codes and appropriate place of service for the billing provider.

Services must represent real‑time interaction between a member at the originating site and a provider at a distant site to be eligible for reimbursement.

Non‑reimbursable services (these are NOT covered)

Non‑direct member services other than Remote Patient Monitoring.
Services that require equipment and/or direct physical hands‑on care that cannot be provided remotely.
Services rendered by audio‑only communication.
Services rendered virtually that are not eligible for reimbursement when rendered to the member in‑person.
Services rendered by facsimile, e‑mail, instant messaging, electronic charting, or other electronic communication (non‑real‑time methods).
PT/OT/ST services provided without live audio/visual communication.

Note: In‑person services not rendered in an office or facility setting are not eligible for virtual reimbursement under this policy.

Coding, Modifiers, and Place of Service

Telehealth ModifiersModifier | HCPCSCovered

95	Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System
GT	Via interactive audio and video telecommunication systems
GQ	Via asynchronous telecommunications system

Remote Patient MonitoringCPT | HCPCSCovered

Remote patient monitoring CPT/HCPCS codes (refer to coding tables / related policies)

Place of Service for synchronous audio-visual visits

Allowed Place of Service codesUse Place of Service '02' (Telehealth) or '10' (Telehealth provided in the office) for synchronous audio-visual visits

Supporting billing elementsInclude the appropriate CPT/HCPCS code per Related Policies when billing telehealth services

Modifier requirementApply the applicable telehealth/telemedicine modifier as indicated in Related Coding when required

Authorization and Provider Requirements

Note

Follow authorization, medical necessity, and proper coding/documentation

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis and may require authorization per the member's benefit plan and state/federal mandates. Claims must use industry-standard CPT/HCPCS/revenue codes and be fully supported in the medical record; failure to follow proper billing/submission or coding guidelines may result in claim rejection, denial, or recoupment.

Verify member benefits and obtain prior authorization when the procedure or diagnosis requires it under the member's benefit plan or applicable mandates.
Bill services with appropriate CPT, HCPCS and/or revenue codes and include documentation in the medical record to support the billed services.
Follow state and federal mandates that may supersede this policy; noncompliance can lead to claim denial, rejection, or recovery of payments.

Definitions

Distant Site definition

TermDistant Site

DefinitionThe site where the physician or practitioner providing the professional service is located at the time the service is provided via a telecommunications system.

Context of useApplies to the location of the billing clinician for professional virtual visits delivered via telecommunication

Originating Site definition

TermOriginating Site

DefinitionThe location of the member at the time the service is furnished via a telecommunications system.

Context of use