CurrentBlue KCPolicy POL-PP- 109

Telehealth Services — Provider Payment Policy

Governance of Blue KC reimbursement and payment integrity practices for telehealth services across applicable commercial and Medicare Advantage lines of business; affects professional providers and entities submitting telehealth claims to Blue KC.

Policy Summary

PayerBlue KC

PolicyTelehealth Services — Provider Payment Policy

Policy CodePolicy POL-PP- 109

Change TypeCode additions and clarifications (2025 telehealth codesMedicare list exception)

Effective DateJul 1, 2019

Next Review Date

Key ActionSubmit telehealth services that appear on the Medicare approved list; Blue KC also accepts 98000-98016 and office visit codes 99202-99215 for telehealth with POS 02 or 10.

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 with telehealth place of service code 02 or 10.

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

Blue KC follows the Medicare List of Approved Telehealth Services but will allow codes 98000-98016 which Medicare has not adopted.

Revenue code 0780 (Telehealth general classification) is mutually exclusive to other telehealth services and is not separately reimbursable.

02,10Telehealth POS accepted

98000-98016New telehealth CPT range accepted

Q3014,0780Originating site codes restricted

95,GT,GQ,G0Accepted modifiers (informational)

Professional providersImpacted provider type

Telehealth Coverage Criteria

Telehealth coverage criteria

Covered when ALL of the following are met:

Telehealth services must appear on the Medicare List of Approved Telehealth Services to be considered for reimbursement, except Blue KC will accept codes 98000-98016 which Medicare has not adopted.

Telehealth evaluation and management services may be billed using new telehealth CPT codes 98000-98016 or office visit E/M codes 99202-99215 when billed with telehealth Place of Service (POS) 02 or POS 10.

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

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

Policy Summary

PayerBlue KC

PolicyTelehealth Services — Provider Payment Policy

Policy CodePolicy POL-PP- 109

Change TypeCode additions and clarifications (2025 telehealth codesMedicare list exception)

Effective DateJul 1, 2019

Next Review Date

Key ActionSubmit telehealth services that appear on the Medicare approved list; Blue KC also accepts 98000-98016 and office visit codes 99202-99215 for telehealth with POS 02 or 10.

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.

Accepted Codes and Coding Rules

Accepted telehealth E/M/CPT codesCPTCovered

98000-98016	New 2025 telehealth CPT codes accepted by Blue KC
99202-99215	Office visit E/M codes allowed for telehealth evaluation and management services
99441-99443	Audio-only telephone services deleted and replaced (legacy codes)

Originating site facility codesHCPCS|RevenueCovered

Q3014	Telehealth originating site HCPCS (mutually exclusive)
0780	Telehealth general classification revenue code (not separately reimbursable)

Medicare approved list requirement

Medicare list requirementTelehealth services must appear on the CMS Medicare List of Approved Telehealth Services to be considered for reimbursement by Blue KC.

Blue KC exceptionsBlue KC will allow specific telehealth CPT codes (98000-98016) even if Medicare has not adopted them.

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

Documentation standardDocumentation requirements for telehealth are the same as face-to-face encounters; best practice is to note telehealth delivery, patient and provider locations, and participants' names/roles.

Claim Submission and Billing Requirements

Billing Rule

Claim submission and required information

Submit telehealth claims for services that appear on the Medicare List of Approved Telehealth Services. Blue KC additionally accepts new telehealth CPT codes 98000-98016 and office visit E/M codes 99202-99215 for telehealth when billed with place of service 02 or 10. Modifiers 95, GT, GQ and G0 are accepted as informational only and are not required. Documentation requirements are the same as face-to-face encounters; best practice is to note the service was provided via telehealth, patient and provider locations, and names/roles of participants.

Bill telehealth services that appear on the Medicare List of Approved Telehealth Services, unless using Blue KC‑accepted codes 98000-98016.
When using telehealth for E/M, you may bill 98000-98016 or 99202-99215 with POS 02 or POS 10.
Modifiers 95, GT, GQ, G0 are informational only if reported; they are not required.
Maintain documentation equivalent to face-to-face encounters and note telehealth modality, patient/provider locations, and participant names/roles.

Billing Rule

Originating site billing restriction

Do not bill HCPCS Q3014 or revenue code 0780 separately with other telehealth services; these are considered mutually exclusive to other telehealth services and are not separately reimbursable. Blue KC will not reimburse telehealth charges billed for non-direct patient services (e.g., labs, immunizations, drug injections).

Do not submit Q3014 or revenue code 0780 in addition to other telehealth service charges for the same encounter.
Exclude non-direct patient services from telehealth reimbursement claims (labs, immunizations, drug injections).

Definitions

Telehealth

Definition of telehealthTelehealth refers to delivery of healthcare services using technology (e.g., video conferencing or remote monitoring) to patients located separately from the provider.

Accepted place of serviceTelehealth E/M services may be billed with telehealth Place of Service codes (e.g., POS 02 or POS 10 for home), per Blue KC coding guidance.

Accepted codes and transitionBlue KC accepts new telehealth CPT codes (98000-98016) and allows office visit E/M codes (99202-99215) for telehealth when billed with appropriate telehealth POS; audio-only legacy codes 99441-99443 were deleted and replaced by 98008-98015.

Originating site

Originating site definitionThe originating site is the location where the patient is located and receives medical services through a telecommunications system.

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

Non-reimbursable services at originating siteBlue KC will not reimburse telehealth services for non-direct patient services such as labs, immunizations, or drug injections.