CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Temporary cost-share waiver for COVID-19 diagnostic testing-related visits

Temporary BCBSRI policy waiving member cost sharing (deductible, copay, coinsurance) for in-person, telemedicine/telehealth/telephone, urgent care and emergency department visits that result in an order or administration of a COVID-19 diagnostic test or evaluation to determine the need for such testing. Applies to BlueCHiP for Medicare and Commercial products during the policy effective period.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTemporary cost-share waiver for COVID-19 diagnostic testing-related visits

Policy CodePolicy N/A

Change TypeTemporary policy

Effective DateMar 18, 2020

Next Review DateN/A

Key ActionFile claims using the listed E/M codes with an applicable diagnosis from this policy and include modifier CS for qualifying BlueCHiP for Medicare visits (use CR on telemedicine/telehealth/telephone services as requested).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

No cost shareDeductible/copayment/coinsurance waived for qualifying visits

2020-03-18Policy effective date

TemporaryDuration

E/M codesRelevant CPT/HCPCS groups

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Policy summary & scope

This is a temporary BCBSRI policy that waives member cost sharing (deductible, copayment, and coinsurance) for qualifying visits associated with COVID-19 diagnostic testing. The waiver applies to in-person office visits, urgent care visits, emergency department visits, and telemedicine/telehealth/telephone encounters when the visit results in an order for or administration of an in vitro diagnostic test for SARS-CoV-2 or is an evaluation to determine the need for such testing. The policy aligns with federal requirements in the Families First Coronavirus Response Act to cover COVID-19 diagnostic testing and related visits without cost sharing during the emergency period.

This temporary waiver applies to BlueCHiP for Medicare and Commercial products when claims are filed with the applicable E/M codes (for example, 99201-99215 and 99281-99285) and an appropriate diagnosis listed in the policy. Clinical documentation must support that the visit resulted in an order or administration of a COVID-19 diagnostic test or was an evaluation to determine the need for testing; providers should retain documentation per usual medical record requirements.

BCBSRI will suspend authorization and referral requirements for services covered under this policy during the timeframe it is in effect. The policy is intended to operate only for services that relate to furnishing or administering an FDA-approved/cleared/authorized in vitro diagnostic product for detection/diagnosis of SARS-CoV-2, or to the evaluation for determining the need for such a product.

Criteria for cost-share waiver

Waiver applies only when visit results in an order or administration of a COVID-19 diagnostic test or evaluation to determine need for such test during the emergency period.

ALL of the following

Date of service is on or after March 18, 2020 and within the emergency period defined by law or while this temporary policy is in effect
Service is an in-person office visit, urgent care visit, emergency department visit, telemedicine/telehealth or telephone encounter
Visit results in an order for or administration of an in vitro diagnostic product for detection/diagnosis of SARS-CoV-2 OR the visit is for evaluation to determine the need for such testing

Relevant codes and modifiers

Evaluation & Management services (no cost share when criteria met)CPTCovered

99201-99215	Office/Outpatient E/M services
99281-99285	Emergency Department E/M services

ICD-10 diagnosis codes (associated with waived visits)ICD-10

B97.21	SARS-associated coronavirus as the cause of diseases classified elsewhere
B34.2	Coronavirus infection, unspecified
B97.29	Other coronavirus as the cause of diseases classified elsewhere
U07.1	2019-nCoV acute respiratory disease
Z20.828	Contact with and (suspected) exposure to other viral communicable diseases
Z03.818	Encounter for observation for suspected exposure to other biological agents ruled out
Z11.59	Encounter for screening for other viral diseases

Modifiers for BlueCHiP for MedicareModifier

CS	Cost sharing waiver modifier (to be accepted for qualifying visits during PHE for Medicare)
CR	Catastrophe/disaster-related modifier — BCBSRI requests CR on telemedicine/telehealth/telephone services for tracking (Medicare Advantage requires CR for telemedicine evaluations)

Billing, documentation and submission requirements

Billing Rule

Claims filing and coding

Claims must be filed using the appropriate E/M codes and an applicable diagnosis from this policy. For BlueCHiP for Medicare members, accept modifier CS for qualifying medical visits during the PHE; BCBSRI requests the CR modifier on telemedicine/telehealth/telephone services (Medicare Advantage requires CR).

99201-99215
99281-99285
B97.21
B34.2
B97.29
U07.1
Z20.828
Z03.818
Z11.59
Modifier CS
Modifier CR

Key defined terms

Definitions

In vitro diagnostic productDiagnostic tests/products for detection of SARS-CoV-2 approved/cleared/authorized by FDA (per cited federal law sections).

Emergency periodThe emergency period defined in section 11350 (per Families First Coronavirus Response Act) during which the coverage and waivers apply.

Policy dates & review

Effective date: 2020-03-18. Policy last reviewed: 2020-04-02. Next review: Not specified.

There is no material change noted for this temporary policy. BCBSRI reserves the right to implement or revoke this policy without the normal sixty-day contractual notice due to the urgent nature of the pandemic; the policy may be changed or withdrawn as circumstances require.

For BlueCHiP for Medicare members, when qualifying visits occur between March 18, 2020 and the end of the Public Health Emergency, BCBSRI will accept modifier CS on qualifying medical visits and requests the CR modifier on telemedicine/telehealth/telephone services for tracking and consistency (Medicare Advantage requires CR for telemedicine evaluations).