CurrentBlue Cross Blue Shield - OklahomaPolicy CPCP033

Telemedicine and Telehealth/Virtual Health Care Services Policy

Governs payment and coding for telemedicine, telehealth, and virtual health care services when provider and member are not co-located; affects eligible providers billing Blue Cross Blue Shield - Oklahoma.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyTelemedicine and Telehealth/Virtual Health Care Services Policy

Policy CodePolicy CPCP033

Change TypeNo material change

Effective DateSep 26, 2025

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7telemedicine modifiers recognized

POS 02,10required POS codes

98000-98016AMA telemedicine E/M codes

Q3014originating site fee guidance

Record timeskey documentation items

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Coverage and billing rules

Services provided via telemedicine/telehealth/virtual health care are covered when coding, documentation, licensing, and billing rules are met; specific modifiers, Place of Service (POS) codes, facility fee guidance, and time-based code requirements apply.

ALL of the following

The provider must maintain complete and accurate medical records including start and end times of the telemedicine/telehealth or virtual health care service.
The method of communication must be documented.
HIPAA-compliant procedures and applicable federal and state privacy laws must be implemented for member communications, recordings, and medical records.
Qualified providers must possess the necessary license to treat members of the Plan's state.

ALL of the following

Append telemedicine/telehealth modifier to the HCPCS or CPT code when billing non-telemedicine procedure codes: FQ, FR, G0, GT, GQ, 93, or 95 as appropriate.
Only non-telemedicine procedure codes require a telemedicine modifier; telemedicine-specific procedure codes may be billed without these modifiers.
Modifier FQ = service furnished using audio-only communication technology; FR = supervising practitioner present via two-way audio/video; G0 = telehealth services for acute stroke; GT = via interactive audio and video; GQ = via asynchronous telecommunications; 93 = synchronous audio-only; 95 = synchronous audio/video.
Modifier G0 will only be accepted when modifier GQ, GT, and/or 95 are appended to the service.

ALL of the following

Professional claims on CMS 1500 for telehealth/telemedicine must be submitted with POS code '02' or '10' and providers should submit the POS that accurately describes where services were rendered.
POS 02 = Telehealth Provided Other than in Patient's Home (patient not located in home).
POS 10 = Telehealth Provided in Patient's Home (patient located in their home).
Q3014 (originating site facility fee) may be billed by the provider supplying the room and telecommunication equipment with the member physically present (the originating site); an outside specialist located elsewhere may not bill Q3014.
POS 02 does not apply to originating site facilities when billing a facility fee.

ALL of the following

If audio-video connection is lost and only audio is restored, report the service that represents the majority of the interactive time.
For audio-only services, more than ten minutes of medical discussion or patient observation must be exceeded to bill as audio-only E/M per the audio-only code requirements.

ALL of the following

AMA telemedicine-specific E/M codes 98000–98016 have specific total time minimums and MDM requirements that must be met for reimbursement.
Examples: 98000 (straightforward MDM) requires total time >= 15 minutes; 98001 requires 30 minutes; 98002 requires 45 minutes; 98003 requires 60 minutes. Established-patient equivalents have lower time thresholds as listed in the policy.
Synchronous audio-only equivalents (98008–98015) require the same MDM level plus >10 minutes of medical discussion and meet the listed total time thresholds (e.g., 98008 requires total time >=15 minutes).
Prolonged services
- When reported time exceeds the stated maximum (e.g., services greater than 75 minutes for certain codes), prolonged service code 99417 may be reported as applicable.

ALL of the following

CPT/HCPCS codes 99421–99423, 98970–98972, 98016 and Q3014 are appropriate when their specific requirements are met; text messaging alone does not meet requirements for digital E/M or virtual check-in services.
It is not appropriate to bill a standard E/M code with modifier GQ when an asynchronous telemedicine code is more appropriate or when required elements for the standard E/M are not met.

ALL of the following

Providers must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to review against benefit documents, contracts, and coding policies.

ALL of the following

Check current AMA/CPT guidance for codes appropriate to modifiers 93 and 95 (appendices and indicators in the CPT codebook).
Providers should ensure the correct combination of POS, modifier, and code is used; follow originating site guidance for Q3014 to avoid inappropriate billing (not to be used for virtual-type visits or equipment use alone).

ALL of the following

Q3014 is inappropriate to bill for virtual-only visits or for use of equipment where the originating site criteria are not met.

ALL of the following

Failure to meet documentation, modifier, POS, licensing, or code-specific time requirements may trigger claim denial or request for additional information and review.

Codes, Modifiers, and Time-Based Billing Guidance

Telemedicine modifiersModifierCovered

FQ	Audio-only communication technology
FR	Supervising practitioner present via two-way audio/video communication technology
G0	Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke
GT	Via interactive audio and video telecommunications systems
GQ	Via asynchronous telecommunications systems
93	Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system
95	Synchronous telemedicine services rendered via real-time interactive audio and video telecommunications system

Telemedicine/telehealth CPT/HCPCS referencedmixedCovered

99421-99423	Online digital E/M services (physician)
98970-98972	Nonphysician online digital assessment and management services
98016	Brief Synchronous Communication Technology Service (e.g., Virtual Check-in)
Q3014	Telehealth originating site facility fee

Notesmixed

Asynchronous telemedicine should use appropriate asynchronous codes (do not append GQ to standard E/M codes when an asynchronous code is appropriate).

Time-based minimums for telemedicine E/M codes

98000 (new pt) / 98004 (established)Straightforward MDM — total time requirement: 15 minutes (new) / 10 minutes (established).

98001 / 98005Low MDM — total time requirement: 30 minutes (new) / 20 minutes (established).

98002 / 98006Moderate MDM — total time requirement: 45 minutes (new) / 30 minutes (established).

98003 / 98007High MDM — total time requirement: 60 minutes (new) / 40 minutes (established). Services greater than thresholds may be reported with prolonged service code 99417.

Audio-only equivalents (98008–98015)Require same MDM level plus more than 10 minutes of medical discussion; time thresholds mirror the corresponding audio-video codes (e.g., 98008 = 15 mins new / 98012 = 10 mins established; 98011 = 60 mins new / 98015 = 40 mins established).

Definitions and Service Types

Audio-only visits — definition and scope

DefinitionAudio only visits: The use of a telephone for visits without video.

ScopeCovers encounters conducted solely by voice where no video or audiovisual component is used; when audio-video connection is lost and only audio is restored, report the service type that accounted for the majority of the interactive time and note that audio-only services require more than 10 minutes of medical discussion.

Coding noteSynchronous Audio-Only E/M CPT codes (98008–98015) apply when audio-only criteria are met; see corresponding time and MDM requirements.

Live video — definition

DefinitionLive video (synchronous): a two-way, face-to-face interaction between a member and a provider using audiovisual communications technology.

Delivery methodConsidered synchronous — real-time interactive audio and video communications; use interactive electronic telecommunications equipment that permits two-way live interaction.

When to useAppropriate when visual assessment or real-time interaction is required and as allowed by state and federal laws and HIPAA-compliant technology guidance.

Telemedicine service — definition

DefinitionTelemedicine service: The use of a telecommunication system to provide services for the purpose of evaluation and treatment when the patient is at one location and the rendering provider is at another location.

ScopeApplicable when provider and patient are not co-located and the service is delivered using telecommunications for evaluation and treatment; providers must be licensed to treat members in the Plan's state.

Documentation/codingFollow coding, documentation, licensing, and billing rules; append applicable telemedicine modifiers and place-of-service codes as required.

Telehealth service — definition

DefinitionTelehealth service: The use of electronic information and telecommunications technologies to support long distance clinical health care, patient and professional health-related education, public health, and health administration.

Typical interactionsOften describes provider-to-provider interaction or indirect provider-to-patient interaction and can include education and administration activities.

Relation to telemedicineTelehealth is broader in scope and may encompass telemedicine services focused on direct evaluation and treatment.

Virtual Health Care — definition

DefinitionVirtual Health Care: Encompasses care rendered by synchronous and asynchronous delivery methods and includes two-way video, email, smart phones, wireless tools, store-and-forward, and remote monitoring.

Delivery methods includedSynchronous (live audio-video), asynchronous (store-and-forward), e-visits, mobile health, virtual check-ins, and remote monitoring services.

Use considerationsProviders should utilize appropriate methods per the service needed and follow state/federal laws and HIPAA-compliant technology guidance.

OpenPayer

Telemedicine and Telehealth/Virtual Health Care Services Policy

Coverage and Billing Rules for Telemedicine/Telehealth

Codes, Modifiers, and Time-Based Billing Guidance

Documentation, Claims, and Provider Responsibilities

Definitions and Service Types