CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Payment Policy Telemedicine/Telephone Services for Medicare Advantage Plans During COVID-19 PHE

Governs coverage and reimbursement for telehealth, telemedicine, and telephone-only services for Blue Cross & Blue Shield of Rhode Island Medicare Advantage (BlueCHiP for Medicare) plans during the COVID-19 Public Health Emergency (PHE). Affects participating providers billing Medicare Advantage members under BCBSRI guidance.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTelemedicine/Telephone Services for Medicare Advantage Plans During COVID-19 PHE

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionFile telehealth claims with POS 02 and Modifier 95; telephone-only services filed with POS 02.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

100%Reimbursement

POS 02 + Modifier 95Telehealth claim filing

Waived (selected codes)Selected cost-share waiver

May furnishRHCs/FQHCs

Telemedicine and Telephone Coverage Criteria

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Telemedicine/Telephone coverage criteria

Coverage and reimbursement when telemedicine criteria are met and claims are filed correctly:

Telemedicine and telephone services listed in the policy/grid are covered as telemedicine/telephone services when the telemedicine criteria in this policy are met.

BCBSRI will reimburse telemedicine or telephone-only encounters at 100% of the in‑office allowable amount for any clinically appropriate, medically necessary covered health service.

Services performed by advanced practitioners will be reimbursed at a reduced proportion of the physician fee schedule consistent with in‑office practice.

Selected codes/services provided by primary care providers and listed behavioral health providers have no member cost share for BCBSRI 2021 Medicare Advantage plans; other specialties are subject to applicable cost share.

ALL of the following

Telehealth (real-time audio/video) claims must be filed with Place of Service (POS) 02 and Modifier 95.
Telephone-only service claims must be filed with Place of Service (POS) 02.
Claims with CPT codes not listed on the attached grid filed with POS 02 and/or Modifier 95 may be denied as invalid place of service and considered provider liability.

RHCs and FQHCs may furnish any Medicare telehealth service included on the Medicare telehealth list during the COVID-19 PHE; some services may be furnished audio-only per CMS guidance.

Benefits and coverage may vary by group and contract; refer to the member's Evidence of Coverage for contract‑specific terms.

Billing Codes and Claim Filing

Telemedicine/Telephone codes (see attached grid)mixedCovered

No codes listed

Claim filing requirements — telehealth/telephone (summary)

Telehealth (real-time audio/video)Claims for telemedicine services must be filed with Place of Service (POS) 02 and Modifier 95.

Telephone-only servicesClaims for telephone-only services must be filed with Place of Service (POS) 02.

Invalid filingsClaims filed with CPT codes not listed on the attached grid using POS 02 and/or Modifier 95 may be denied as invalid place of service and be provider liability.

Definitions and Modifiers

Telehealth / Telemedicine (definition)

DefinitionTelehealth/telemedicine: exchange of medical information from one site to another through electronic communication to improve a patient’s health.

PurposeUsed to provide routine care and care for vulnerable members during the COVID-19 Public Health Emergency to limit community spread.

ScopeIncludes interactive audio/video and telephone modalities as described in CMS guidance during the PHE.

Modifier 95

Modifier descriptionModifier 95: Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system.

Use caseApplied to claims for telemedicine services that are delivered via real-time interactive audio and video.

Claim filing requirementWhen billing telemedicine (real-time audio/video) services, include Modifier 95 in addition to POS 02.

Place of Service (POS) 02

POS 02 descriptionPlace of Service (POS) 02: The location where health services and health-related services are provided or received through telehealth telecommunication technology.

When to useUse POS 02 for telehealth services delivered via telecommunication technology, including telephone-only services.

Claims noteClaims for telemedicine services must be filed with POS 02; incorrect POS may result in denial as invalid place of service.