BCBSWY Telemedicine Services
This document governs BCBSWY coverage, coding, place-of-service, and modifier guidance for telemedicine, telephonic, e-visits, virtual check-ins, and home health telemedicine for BCBSWY members and professional providers.
No material clinical or coverage changes in this revision.
Telemedicine Coverage Criteria
Telemedicine coverage criteria
Covered when conditions below are met; specific modalities and some codes are excluded per member benefits.
Telemedicine modalities covered
- Synchronous audio-video visits (CPT/HCPCS 98000-98007) are a benefit and covered subject to member's benefits; use standard place of service codes and GT/95 modifier is not required for these codes.
- Inpatient telemedicine encounters within the same facility are permitted for professional services; bill with inpatient hospital place of service and append GT or 95 modifier as applicable.
- Outpatient telemedicine and telephonic visits may be rendered to the patient's home; bill with appropriate POS and append GT or 95 modifier as applicable.
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