CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Telemedicine/Telephone Services for Medicare Advantage Plans During COVID-19 Public Health Emergency (PHE)

Temporary reimbursement and coding guidance for telehealth and telephone services for BCBSRI Medicare Advantage plans during the COVID-19 Public Health Emergency; applies to providers submitting claims to BCBSRI for affected MA members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTelemedicine/Telephone Services for Medicare Advantage Plans During COVID-19 Public Health Emergency (PHE)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2021

Next Review DateN/A

Key ActionSubmit telemedicine (audio-video) claims with POS 02 and modifier 95; telephone-only claims with POS 02; no prior authorization required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

100%reimbursement of telemedicine/telephone services at in‑office allowable

POS 02 + modifier 95required claim filing elements for telemedicine with audio‑video

POS 02required claim filing element for telephone‑only services

Cost share waivedselected codes have no member cost share per 2021 MA benefits

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Telemedicine / Telephone Coverage During the PHE

Telemedicine/Telephone coverage criteria during PHE

Covered when ALL of the following conditions are met:

Services must be clinically appropriate and medically necessary and covered under the member's contract.

Provider is an eligible furnishing provider type per policy (e.g., physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals).

Claims for telemedicine (synchronous audio-video) services are submitted with Place of Service (POS) 02 and modifier 95 as required for telehealth claims processing.

Claims for telephone-only services are submitted with Place of Service (POS) 02.

Reimbursement: BCBSRI will reimburse telemedicine or telephone-only services at 100% of the in-office allowable amount for any clinically appropriate, medically necessary covered health service; services by advanced practitioners are reimbursed at the same reduced proportion of the physician fee schedule as for in-office services.

Selected codes/services provided by primary care and specified behavioral health providers have no member cost share per applicable 2021 Medicare Advantage benefits; other providers' usual cost share applies.

RHCs and FQHCs may furnish Medicare telehealth services, and certain services may be furnished audio-only during the PHE in accordance with CMS guidance.

Limitation: Appearance of a code on BCBSRI's coding grid does not guarantee separate reimbursement; codes not listed or not filed as noted may deny as invalid POS or be subject to Non-Reimbursable Health Service Codes policy.

Operational note: This policy is temporary and tied to the Public Health Emergency; BCBSRI may implement or revoke sections without the normal 60-day notice and will communicate updates via the provider portal.

Covered Codes and Claim Filing Requirements

Covered telemedicine/telephone CPT/HCPCS codesmixedCovered

No codes listed

Claim filing requirements — Telemedicine/Telephone (2021 PHE guidance)

Telemedicine (audio-video)Claims must be filed with Place of Service (POS) 02 AND Modifier 95.

Telephone-only servicesClaims must be filed with Place of Service (POS) 02 (no modifier 95 required).

Invalid POS filingAny claim filed with a CPT code not listed on the covered grid with POS 02 and/or Modifier 95 may deny as invalid place of service and be provider liability.

Provider Requirements and Billing Actions

Prior Authorization

No prior authorization required

No prior authorization is required for telemedicine or telephone services under this policy.

Key Definitions

Telehealth / Telemedicine — definition and CMS PHE expansion

PHE expansion (CMS)During the COVID-19 Public Health Emergency CMS temporarily broadened access to Medicare telehealth services via the 1135 waiver, expanding services, settings, and provider types able to furnish telehealth.

PurposeExpand access to care, limit community spread of COVID-19, and allow members to receive services from home.

Place of Service (POS) 02 and Modifier 95 usage

Place of Service (POS) 02Indicates telehealth location: the location where health services and health related services are provided or received through telehealth telecommunication technology.

Modifier 95Indicates a synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system (used with POS 02 for audio-video telemedicine).

Telephone-only filing