CurrentBlue KCPolicy POL-PP- 109

Telehealth Services — Payment Integrity

Defines Blue KC's payment and coverage rules for telehealth services, who may bill, accepted codes and billing practices, documentation expectations, and lines of business affected. Applies to providers submitting claims to Blue KC for telehealth services.

Policy Summary

PayerBlue KC

PolicyTelehealth Services — Payment Integrity

Policy CodePolicy POL-PP- 109

Change TypeNew 2025 telehealth codes acceptedaudio-only codes replaced and mutual exclusivity clarified

Effective DateJul 1, 2019

Next Review DateN/A

Key ActionUse place of service 02 or 10 when billing telehealth E/M codes and do not bill Q3014 or revenue code 0780 in addition to other telehealth services.

SourceLink

POLICY UPDATE CHANGES

Blue KC will accept new 2025 telehealth codes 98000-98016 and office visit codes 99202-99215 for telehealth E/M services when billed with telehealth place of service 02 or 10.

Audio-only telephone services CPT 99441-99443 were deleted and replaced with 98008-98015.

HCPCS Q3014 and revenue code 0780 are mutually exclusive to other telehealth services and not separately reimbursable.

Blue KC follows the Medicare List of Approved Telehealth Services, with exception for codes 98000-98016 which Medicare has not adopted.

2019-07-01Original effective date

7/1/2025Revision noted

98000-98016Accepted E/M codes

Policy Summary

PayerBlue KC

PolicyTelehealth Services — Payment Integrity

Policy CodePolicy POL-PP- 109

Change TypeNew 2025 telehealth codes acceptedaudio-only codes replaced and mutual exclusivity clarified

Effective DateJul 1, 2019

Next Review DateN/A

Key ActionUse place of service 02 or 10 when billing telehealth E/M codes and do not bill Q3014 or revenue code 0780 in addition to other telehealth services.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Telehealth Coverage Criteria

Telehealth coverage criteria

Telehealth services are covered when they meet the coding, billing, provider eligibility, and documentation requirements below.

Service must appear on the Medicare List of Approved Telehealth Services to be considered for reimbursement, except Blue KC accepts codes 98000-98016 even if Medicare has not adopted them.

Use Place of Service (POS) 02 (telehealth) or POS 10 (telehealth provided in patient’s home) when billing telehealth E/M codes 98000-98016 or office visit E/M codes 99202-99215 for telehealth encounters.

Modifiers 95, GT, GQ, and G0 are accepted as informational only if reported on claims for eligible telehealth services; they are not required to identify telehealth services.

Distant site practitioners eligible to provide and receive payment for covered telehealth services (subject to state law) include physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologists, clinical social workers, and registered dietitians/nutrition professionals.

Documentation requirements for telehealth services are the same as face-to-face encounters; best practice is to document that the service was provided via telehealth, the locations of the patient and provider, and the names/roles of any other participants.

Exclusions and mutually exclusive billing

Blue KC will not reimburse telehealth services for non-direct patient services (for example: laboratory services, immunizations, drug injections).
HCPCS Q3014 (telehealth originating site) and revenue code 0780 (telehealth general classification) are considered mutually exclusive to other telehealth services and are not separately reimbursable.

Final payment is subject to member eligibility, benefits, and claim adjudication; check member cost-share guidance as post-PHE cost share and extended access notes may apply.

Accepted Codes and Coding Guidance

Covered CPT CodesCPTCovered

98000-98016	New 2025 telehealth E/M codes accepted by Blue KC (audio-only replacements and E/M telehealth).
99202-99215	Office visit E/M codes accepted for telehealth evaluation and management services when billed with telehealth place of service 02 or 10.

Deleted / Replaced CPT CodesCPTNot Covered

99441-99443

Audio-only telephone services removed/deleted and replaced by new 98008-98015 series.

Mutually exclusive / Not separately reimbursablemixedNot Covered

Q3014	Telehealth originating site — mutually exclusive to other telehealth services; not separately reimbursable.
0780	Telehealth general classification revenue code — mutually exclusive and not separately reimbursable.

Accepted (Informational) ModifiersModifier

95	Accepted as informational only; not required to identify telehealth services.
GT	Accepted as informational only; not required to identify telehealth services.
GQ	Accepted as informational only; not required to identify telehealth services.
G0	Accepted as informational only; not required to identify telehealth services.

Medicare‑approved telehealth requirement

Medicare-approved telehealth requirementTelehealth service must appear on the Medicare List of Approved Telehealth Services to be considered for reimbursement by Blue KC (Blue KC follows the Medicare list).

Accepted informational modifiersModifiers 95, GT, GQ and G0 are accepted as informational only; they are not required to identify telehealth services.

Place of service guidanceUse telehealth place of service codes (e.g., POS 02) when billing telehealth services where applicable.

Eligible distant site practitionersPhysicians, nurse practitioners, physician assistants, nurse‑midwives, clinical nurse specialists, CRNAs, clinical psychologists, clinical social workers, and registered dietitians/nutrition professionals may provide and receive payment for covered telehealth services (subject to state law).

Documentation expectationsDocumentation requirements for telehealth are the same as face‑to‑face encounters; best practice is to note that the service was provided via telehealth and record patient and provider locations and participant names/roles.

Billing, Authorization, and Documentation Requirements

Billing Rule

Prior authorization, billing and documentation requirements for telehealth

Blue KC follows the Medicare List of Approved Telehealth Services; to be considered for reimbursement a telehealth service must appear on that Medicare list (Blue KC makes an exception for codes 98000–98016). Use place of service 02 (telehealth) or 10 (telehealth in the patient’s home) when billing telehealth E/M services such as 98000–98016 or 99202–99215. Modifiers 95, GT, GQ and G0 are accepted only as informational and are not required. Documentation for telehealth encounters must meet the same requirements as face-to-face visits; best practice is to state that the service was provided via telehealth, record the patient and provider locations, and list names/roles of any other participants. Do not bill HCPCS Q3014 or revenue code 0780 in addition to other telehealth services — they are mutually exclusive and not separately reimbursable. Blue KC will not reimburse telehealth for non-direct patient services (for example: lab, immunizations, drug injections).

Ensure telehealth service appears on the Medicare List of Approved Telehealth Services for reimbursement (exception: Blue KC accepts 98000–98016 despite Medicare non-adoption).
When billing telehealth E/M codes (98000–98016 or 99202–99215), use POS 02 or POS 10 as applicable.
Modifiers 95, GT, GQ, G0 are informational only — reporting them is optional.

Key Definitions

Telehealth definition

DefinitionTelehealth refers to delivery of healthcare services using technology (e.g., video conferencing, remote monitoring) to patients in a location different from the provider, enabling access across geographic or mobility barriers.

Examples of technologyVideo conferencing and remote monitoring are cited examples of technology used to deliver telehealth services.

PurposeSupports access for individuals facing geographic or mobility limitations, promotes efficient resource use, and improves patient engagement.

Originating site

DefinitionOriginating site is the physical location where the patient is located and receives medical services through a telecommunications system.

Mutually exclusive codesHCPCS Q3014 and revenue code 0780 (Telehealth general classification) are considered mutually exclusive to other telehealth services and are not separately reimbursable.