BCBSRI follows CMS guidelines for telemedicine/telehealth services during the COVID-19 Public Health Emergency; providers may use telephone or interactive real-time audio and video telecommunications to furnish covered services.
Source: policy statement and background
Benefits and applicability may vary by group and contract; refer to the member's Evidence of Coverage for benefit applicability.
Refer to coverage section
Telemedicine and telephone-only services are reimbursed at 100% of the in‑office allowable for clinically appropriate, medically necessary covered services.
Reimbursement rules
Services performed by advanced practitioners will be reimbursed at a reduced proportion of the physician fee schedule consistent with in‑office practice.
Advanced practitioner reimbursement
Covered provider types include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals, per CMS guidance.
Provider scope
Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) may furnish Medicare telehealth services during the PHE; some services may be furnished via audio‑only.
Special provider allowances
Cost share: Selected primary care and behavioral health telehealth services have no cost share consistent with BCBSRI 2021 Medicare Advantage benefit plans (see coding grid for selected codes/services).
Cost share exception
Claims for interactive telemedicine (real‑time audio/video) must be filed with Modifier 95 and either Place of Service (POS) 10 (patient at home) or POS 02 (patient not at home) as appropriate.
Filing requirements for interactive telemedicine
Telephone‑only claims filing (any of the following):
File with Place of Service (POS) 10 (patient located in their home).
File with Place of Service (POS) 02 (patient not located in their home).
May bill with Modifier FQ to indicate real‑time interactive audio (telephone) — optional, not mandatory.
Coverage of specific CPT/HCPCS codes is conditioned on the code being listed as covered and filed with the specified POS/modifier combination; appearance on the list does not guarantee separate reimbursement.
Coding and reimbursement limitation
Claims filed with a CPT code not listed as covered when submitted with POS 02 or 10 and Modifier 95 or FQ may be considered invalid and could be denied or result in provider liability.
Invalid filing consequence