ModifiedBlue Cross of IdahoPolicy MP 10.01.550

Telehealth Virtual Care Services

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This policy governs when telehealth services may be considered medically necessary, including requirements for professional relationships, standard of care, documentation, credentialing, consent, privacy, and billing. It applies to providers delivering telehealth services to Blue Cross of Idaho members, subject to the member-specific benefit plan and applicable law.

Policy Summary

PayerBlue Cross of Idaho

PolicyTelehealth Virtual Care Services

Policy CodePolicy N/A

Change TypeModified

Effective DateMay 28, 2026

Last ReviewMay 28, 2026

Next Review DateN/A

Key ActionApply Blue Cross of Idaho’s standard prior authorization protocols whether telehealth services are delivered in person or remotely.

SourceLink

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ModifiedBlue Cross of IdahoPolicy MP 10.01.550

Telehealth Virtual Care Services

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Policy Summary

PayerBlue Cross of Idaho

PolicyTelehealth Virtual Care Services

Policy CodePolicy N/A

Change TypeModified

Effective DateMay 28, 2026

Last ReviewMay 28, 2026

Next Review DateN/A

Key ActionApply Blue Cross of Idaho’s standard prior authorization protocols whether telehealth services are delivered in person or remotely.

SourceLink

POLICY UPDATE CHANGES

Updated information and references concerning DEA and HHS extensions of COVID-19 telemedicine prescribing flexibilities.

Added procedure codes for telehealth services.

Updated references.

2Telehealth delivery modalities

3Telehealth reporting modifiers

2-way audio and visualRequired interaction

Not medically necessaryEmergency telehealth coverage

Not coveredPartial Hospital Program telehealth

Telehealth Coverage Criteria

General Telehealth Coverage

Telehealth may be considered medically necessary when all applicable requirements are met.

Medical necessity and professional relationship: The service is a medically necessary diagnostic or therapeutic service; a professional relationship exists or can reasonably be established between the distant-site healthcare professional and the patient in accordance with applicable state laws and regulations.

Coverage and standard of care: The service is a covered service, follows evidence-based standards of care, and is delivered consistently with the applicable Idaho community standard of care and the provider's scope of practice.

Eligible and qualified provider: The provider is recognized as eligible by Blue Cross of Idaho, remains within scope of practice, and the distant-site practitioner has appropriate credentials and licensing.

Safe telehealth delivery: The provider determines that delivery through telehealth is consistent with the standard of care and has access to medical and emergency resources near the patient's location for appropriate referrals when medically indicated.

Treatment and Prescribing

When treatment or prescribing is provided through telehealth, all of the following requirements apply.

Evaluation before treatment: Before providing treatment, including a prescription drug order, the provider obtains and documents relevant clinical history and current symptoms sufficient to establish the diagnosis and identify underlying conditions and contraindications.

Provider-patient relationship: If no established provider-patient relationship exists, the provider takes appropriate steps to establish one using two-way audio and visual interaction when required by applicable law or the Idaho Virtual Care Access Act.

Prescribing authority: The provider prescribes within the scope of the provider's license and applicable laws, rules, and regulations. Controlled substances may be prescribed by telemedicine only in compliance with applicable federal requirements.

Hosted Telehealth Visits

Hosted telehealth visits require all of the following conditions.

Originating-site control and licensure: The examination is under the control of the physician or practitioner at the originating site, and that physician or practitioner is licensed to furnish the services.

Confidential location: The hosted visit occurs in a space within the qualified patient location that permits confidential exchange.

Emergency availability: A medical practitioner is present in the office suite and available to respond to emergencies during the hosted telehealth service.

Telehealth is not medically necessary for emergency situations in which the patient’s life or health is in danger or imminent danger.

Partial Hospital Program services are not covered when furnished in a telehealth place of service.

Telehealth services included in a per diem rate cannot be billed separately.

Partial Hospital Program services are not covered when furnished in a telehealth place of service.

The following telehealth activities are not medically necessary: emergency situations where the patient’s life or health is in danger or imminent danger; generic information not specific to an individual; and reporting test results only. Administrative services, non-HIPAA-compliant email, patient-generated medical history, text messaging, and facsimile transmissions are also excluded from telehealth medical necessity.

Telehealth Coding and Billing

Asynchronous telehealth modifierModifier

GQ	Modifier used to report asynchronous Telehealth services

Synchronous telehealth modifiersModifier

GT	Modifier used to report synchronous Telehealth services
95	Modifier used to report synchronous Telehealth services

CPT telehealth and remote communication codesCPT

98000	Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination
98001	Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination
98002	Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination
98003	Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination
98004	Synchronous audio-video visit for the evaluation and management of an established patient, variable level of decision making and variable minutes
98005	Synchronous audio-video visit for the evaluation and management of an established patient, variable level of decision making and variable minutes
98006	Synchronous audio-video visit for the evaluation and management of an established patient, variable level of decision making and variable minutes
98007	Synchronous audio-video visit for the evaluation and management of an established patient, variable level of decision making and variable minutes
98008	Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination
98009	Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination

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HCPCS remote mental health and home health telehealth codesHCPCS

C7900	Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, variable minutes, provided remotely by hospital staff licensed to provide mental health services under applicable state law when the patient is in their home and there is no associated professional service
C7901	Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, variable minutes, provided remotely by hospital staff licensed to provide mental health services under applicable state law when the patient is in their home and there is no associated professional service
C7902	Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, variable minutes, provided remotely by hospital staff licensed to provide mental health services under applicable state law when the patient is in their home and there is no associated professional service
C7903	Group psychotherapy service for diagnosis, evaluation, or treatment of a mental health or substance use disorder provided remotely by hospital staff licensed to provide mental health services under applicable state law when the patient is in their home and there is no associated professional service
G0320	Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
G0321	Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system

HCPCS inpatient, critical care, and TEAM remote evaluation and management codesHCPCS

G0406	Follow-up inpatient consultation, limited or intermediate or complex, physicians typically spend variable minutes communicating with the patient via telehealth
G0407	Follow-up inpatient consultation, limited or intermediate or complex, physicians typically spend variable minutes communicating with the patient via telehealth
G0408	Follow-up inpatient consultation, limited or intermediate or complex, physicians typically spend variable minutes communicating with the patient via telehealth
G0425	Telehealth consultation, emergency department or initial inpatient, typically variable number of minutes communicating with the patient via telehealth
G0426	Telehealth consultation, emergency department or initial inpatient, typically variable number of minutes communicating with the patient via telehealth
G0427	Telehealth consultation, emergency department or initial inpatient, typically variable number of minutes communicating with the patient via telehealth
G0459	Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy
G0508	Telehealth consultation, critical care, initial or subsequent, physicians typically spend variable minutes communicating with the patient and providers via telehealth
G0509	Telehealth consultation, critical care, initial or subsequent, physicians typically spend variable minutes communicating with the patient and providers via telehealth
G0660	TEAM remote E/M new patient, 10 mins to 60 mins

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HCPCS remote evaluation, distant-site, and virtual check-in codesHCPCS

G2010	Remote evaluation of recorded video and/or images submitted by an established patient, including interpretation with follow-up with the patient within 24 business hours; not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment
G2025	Payment for a telehealth distant site service furnished by a Rural Health Clinic or Federally Qualified Health Center only
G2250	Remote assessment of recorded video and/or images submitted by an established patient, including interpretation with follow-up with the patient within 24 business hours; not originating from a related E/M service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment
G2251	Brief communication technology-based service, such as a virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient; 5-10 minutes of clinical discussion
G2252	Brief communication technology-based service, such as a virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient; 11-20 minutes of medical discussion

Telehealth encounter codesHCPCS

M1426	Encounters conducted via telehealth
M1431	Encounters conducted via telehealth
M1432	Encounters conducted via telehealth
M1436	Encounters conducted via telehealth

Telehealth virtual care procedure codesHCPCS

G2251	Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion.
G2252	Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.
M1426	Encounters conducted via telehealth.
M1431	Encounters conducted via telehealth.
M1432	Encounters conducted via telehealth.
M1436	Encounters conducted via telehealth.
M1437	Encounters conducted via telehealth.
M1440	Encounters conducted via telehealth.
M1442	Encounters conducted via telehealth.
M1443	Encounters conducted via telehealth.

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ICD-10-CM and ICD-10-PCSICD-10

No codes listed

Store-and-forward follow-up timing

Follow-upFollow-up with the patient within 24 business hours.

Prior related serviceThe service must not originate from a related evaluation and management service provided within the previous 7 days.

Subsequent serviceThe service must not lead to an evaluation and management service or procedure within the next 24 hours or soonest available appointment.

Brief virtual check-in clinical discussion

G2251

Provider Requirements and Billing Rules

Prior Authorization

Prior Authorization Applies to Telehealth

Blue Cross of Idaho’s published prior authorization protocols apply to services delivered both in person and through telehealth. Obtain authorization when required before providing the service.

Documentation Required

Document Clinical History and Symptoms

Before providing treatment, including a prescription drug order, obtain and document the member’s relevant clinical history and current symptoms to establish the diagnosis and identify underlying conditions and contraindications.

Documentation Required

Maintain Telehealth Medical Records

Generate and maintain medical records for every member receiving telehealth services in compliance with applicable state and federal laws, including HIPAA. Records must be accessible to other providers as permitted by law and meet PAP 107 Medical Records Standards.

Telehealth Overview

Telehealth may deliver diagnostic and therapeutic care through synchronous real-time interaction or asynchronous store-and-forward communication. Synchronous interaction allows the provider and patient in separate locations to communicate simultaneously through interactive audio and video or audio technology. Asynchronous store-and-forward care involves medical information being transmitted for later review by a physician or practitioner at the distant site, so the patient and clinician do not need to be present at the same time and place. The appropriateness of either modality depends on the existence or establishment of a professional relationship, the applicable standard of care, and the provider’s ability to evaluate and treat the patient safely.

Telehealth Definitions

Asynchronous / Store and Forward

TransmissionAsynchronous transmission of medical information that is reviewed at a later time by a physician or practitioner at the distant site.

Patient and clinician timingThe patient and clinician do not need to be present at the same time and place.

Review workflowInformation is sent to the distant site for later review and interpretation; real-time interpretation is not store and forward.

Distant site

LocationThe site where a health care provider is located while providing health care services through a telecommunications system.

Alternate termsAlso called the hub or consultant site.

Policy Revision History

2021-04-22Policy clarification

Clarified that Partial Hospital Program services are not covered when provided in a telehealth place of service.

2024-03-28Policy update

Updated information and references for the Idaho Virtual Care Access Act and added that the applicable Idaho community standard of care for in-person services also applies in virtual settings.

2025-03-27Policy update

Policy Summary

PayerBlue Cross of Idaho

PolicyTelehealth Virtual Care Services

Policy CodePolicy N/A

Change TypeModified

Effective DateMay 28, 2026

Last ReviewMay 28, 2026

Next Review DateN/A

Key ActionApply Blue Cross of Idaho’s standard prior authorization protocols whether telehealth services are delivered in person or remotely.

SourceLink

On This Page

Brief communication technology-based service for an established patient; 5-10 minutes of clinical discussion.

G2252Brief communication technology-based service for an established patient; 11-20 minutes of medical discussion.

Service typeBoth codes describe brief communication technology-based services, such as a virtual check-in.

TEAM remote E/M duration

New patientTEAM remote evaluation and management: 10-60 minutes.

Established patientTEAM remote evaluation and management: 10-40 minutes.

New-patient codesG0660, G0661, G0662, and G0663.

G2251 clinical discussion

CodeG2251.

Patient statusProvided to an established patient by a qualified health care professional who cannot report evaluation and management services.

Clinical discussion5-10 minutes.

G2252 medical discussion

CodeG2252.

Patient statusProvided to an established patient by a physician or other qualified health care professional who can report evaluation and management services.

Medical discussion11-20 minutes.

Documentation Required

Maintain Consent and Releases

Develop and maintain member consent and all required releases in the patient’s medical record.

Note

Provide Member Information Before the Initial Visit

Before the initial telehealth visit, provide the member with understandable written information explaining telehealth, what to expect, and what will occur. If the member elects to stop using telehealth, cease the service immediately and schedule an alternative appointment.

Documentation Required

Obtain an Operator Confidentiality Agreement

If a nonemployee operator is needed to operate teleconferencing equipment or is present during the session, obtain a signed confidentiality agreement. The operator must agree to comply with HIPAA and all other applicable federal and state laws, and the agreement should be filed with the teleconference documentation.

Billing Rule

Use Applicable Telehealth Coding and POS Guidance

Submit telehealth services using applicable CPT and HCPCS coding standards. Refer to PAP 518 for additional coding requirements, including appropriate place-of-service codes and modifiers.

Denial Risk

Non-Medically Necessary Telehealth Activities

The following telehealth activities are not medically necessary and should not be billed as medically necessary telehealth care: emergency services when life or health is in danger or imminent danger; generic information not specific to an individual; test-result reporting only; and administrative or noncompliant communication activities.

Administrative services such as scheduling, registration, billing-information updates, medication-refill or referral requests, and ordering diagnostic studies.
Patient-completed medical history intake, internet questionnaires, patient-generated medical history, text messaging, facsimile transmissions, and email messaging that is not HIPAA-compliant.

Billing Rule

Services Included in Per Diem

Do not bill telehealth services separately when they are included in a per diem rate.

Denial Risk

Partial Hospital Program Telehealth Exclusion

Partial Hospital Program services are not covered when furnished in a telehealth place of service.

Denial Risk

Coverage, Medical Necessity, and Provider Eligibility

Telehealth services must be covered services, medically necessary, and delivered according to evidence-based standards of care. The provider must also be recognized by Blue Cross of Idaho as an eligible provider, remain within the scope of practice, and ensure the distant-site practitioner has appropriate credentials and licensing.

Denial Risk

Failure to Meet the Standard of Care

Telehealth providers must practice consistently with the applicable Idaho community standard of care for in-person services and within their scope of practice. Failure to meet the standard of care may result in adverse licensure action, even without an adverse outcome, and may create malpractice liability.

Denial Risk

PHP Excluded in Telehealth Place of Service

PHP services are excluded when furnished through a telehealth place of service; do not submit them as covered telehealth services.

RoleThe distant site is where the provider delivers the telecommunications-based service.

Hosted visit

DefinitionA virtual consultation with a remote telehealth health care provider hosted by a provider who is face-to-face with the patient.

Remote clinicianThe clinician providing telehealth services is the consultant and cannot be considered the host.

Virtual visit distinctionThe complexity of a hosted visit excludes it from being a virtual visit.

Originating site

LocationThe physical location of an eligible member at the time the service furnished through a telecommunications system occurs.

Alternate termsAlso called the spoke or patient site.

Member statusThe site must be the eligible member's location when the telecommunications service occurs.

Synchronous interaction

CommunicationReal-time communication through interactive technology.

InteractionA provider and patient in separate locations interact simultaneously.

TechnologyInteraction occurs through two-way video and audio or audio transmission.

Telehealth Virtual Care Services

DefinitionHealthcare services provided through electronic communications, information technology, asynchronous store-and-forward transfer, or synchronous interaction.

Provider locationThe provider is at a distant site.

Patient locationThe patient is at an originating site.

Telehealth technologies

Technology typesSynchronous or asynchronous telecommunications technologies.

Clinical usesTechnologies may assist with assessment, diagnosis, consultation, treatment, and remote monitoring of a patient.

Additional usesTechnologies may support medical-data transfer, patient and professional health-related education, public health services, and health administration.

Virtual Visit

DefinitionAn internet-based episode of physician-patient interaction.

PurposeProvides health services online.

Interaction settingThe interaction occurs through the internet between a physician and patient.

Updated information and references concerning the Drug Enforcement Administration and Health and Human Services extension of COVID-19 telemedicine prescribing flexibilities and added procedure codes.

2026-05-28Material policy updateLatest

Updated prescribing-flexibility information and related references concerning the Drug Enforcement Administration and Health and Human Services extension of COVID-19 telemedicine prescribing flexibilities and added procedure codes.