BCBSWY Telemedicine Services
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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.
Explicit exclusions (not a benefit)
- Synchronous audio-only visits (CPT/HCPCS 98008-98015) are not a benefit and are not reimbursed by BCBSWY.
- e-Visits (CPT 99421-99423; HCPCS G2061-G2063) are not a benefit and are not reimbursed by BCBSWY.
- Virtual check-ins (HCPCS G2010, G2012) are not a benefit and are not reimbursed by BCBSWY.
Billing directives for specific settings
- Inpatient professional telehealth: bill with inpatient hospital place of service; append GT or 95 modifier as applicable.
- Home telehealth: bill with national place of service 10 (Telehealth Provided in Patient Home).
- Home health telemedicine codes (G0320-G0322) will be denied as included; providers should bill the specific home health service rendered on a HCFA-1500 and append GT or 95 as applicable.
Coding and Place-of-Service Guidance
| 98008-98015 | Synchronous audio-only visit series — Not a benefit |
| 99421 | E-visit: online digital evaluation and management (5-10 minutes) — Not reimbursed |
| 99422 | E-visit: online digital evaluation and management (11-20 minutes) — Not reimbursed |
| 99423 | E-visit: online digital evaluation and management (21+ minutes) — Not reimbursed |
| G2061 | E-visit: online digital evaluation and management, typically 5-10 minutes — Not reimbursed |
| G2062 | E-visit: online digital evaluation and management, typically 11-20 minutes — Not reimbursed |
| G2063 | E-visit: online digital evaluation and management, typically 21+ minutes — Not reimbursed |
| G2010 | Virtual check-in (brief communication tech-based service) — Not reimbursed |
| G2012 | Virtual check-in (clinical assessment via brief communication) — Not reimbursed |
Billing, Modifiers, and Provider Requirements
Billing and modifier guidance
Bill telemedicine encounters using the correct place of service and append the GT or 95 modifier when required. For inpatient professional telemedicine, bill with the inpatient hospital place of service and append GT or 95 as applicable; for outpatient telemedicine append GT or 95 as applicable unless the service is a synchronous audio‑video visit, which uses standard POS and does not require GT/95.
- Inpatient telemedicine: bill with inpatient hospital POS and append GT or 95 modifier as applicable. [[CITATION]]
- Outpatient telemedicine: append GT or 95 modifier as applicable with correct coding.
- Synchronous audio‑video visits (codes 98000–98007): use standard place of service codes; GT or 95 modifier is not required.
Permitted service locations
Telephonic and telemedicine visits are permitted at the patient’s home; inpatient telemedicine encounters are permitted within the same facility. Ensure services are appropriate for telemedicine and within the provider’s scope of license.
- Home: telephonic and telemedicine visits may be provided to the patient’s home.
- Inpatient: telemedicine encounters are permitted within the same facility.
Definitions for Telemedicine Modalities
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