ModifiedEmpire BluecrossPolicy C-08002

Virtual Visits - Professional and Facility

Governs reimbursement rules for professional and facility virtual visits (telehealth, audio-only, asynchronous, remote monitoring, originating site) for commercial members of Empire BlueCross/Anthem Blue Cross and Blue Shield; includes state-specific exemptions. Affects professional and facility providers submitting claims.

Policy Summary

PayerEmpire Bluecross

PolicyVirtual Visits - Professional and Facility

Policy CodePolicy C-08002

Change TypeMaterial updates to reimbursable and nonreimbursable virtual visit rulesadded state exemptions

Effective DateJul 1, 2024

Next Review Date

Key ActionEnsure virtual visit claims meet authorization and medical necessity guidelines and use the correct place of service and modifiers for professional and facility billing.

SourceLink

POLICY UPDATE CHANGES

Updated language to state all Virtual Visits performed by professional providers will be subject to non-office reimbursement and added definitions for Asynchronous and Synchronous.

Reimbursable section updated to add professional audio only services and professional asynchronous services; clarified facility audio-video services are allowed for Behavioral Health only.

Nonreimbursable section updated to add Facility Virtual Visits via live audio-video for non-Behavioral Health billed on a UB04 and Facility Virtual Visits via audio only billed on a UB04.

Exemptions were added or updated for multiple states allowing office-based reimbursement or facility virtual visits and audio-only services for certain markets (examples: Colorado, Connecticut, Georgia, Kentucky, Indiana, Missouri, New Hampshire, Nevada).

audio-video; audio-only; async; RPMmodalities addressed

audio-only & asyncprofessional additions

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.

Behavioral Health only

facility restriction

Q3014originating fee

multiplestate exemptions

Coverage Criteria for Virtual Visits

Coverage criteria

Covered when ALL of the following are met:

The Health Plan allows reimbursement for professional or facility virtual visits when interactive services occur between the member and the provider and the parties are not co-located, unless provider, state, or federal contracts and/or mandates indicate otherwise (state mandates override).

Professional virtual visits are reimbursable when rendered at the distant site by professional providers via a secure and private connection.

Professional virtual visit claims are eligible for non-office place of service reimbursement and must be submitted using the appropriate place of service, CPT/HCPCS codes, and telehealth modifier as specified by the payer.

Facility virtual visits are allowed for Behavioral Health services only; the virtual visit must be rendered through a secure and private connection.

Originating site fees (HCPCS Q3014) are allowed for facility providers only when applicable.

Nonreimbursable services under this policy include: non-direct member services other than Remote Patient Monitoring; services that require equipment and/or direct physical hands-on care that cannot be provided remotely; services rendered virtually that are not eligible for reimbursement when rendered to the member in-person; PT/OT/ST provided without live audio and visual communication; facility virtual visits via live audio-video for services that are not Behavioral Health; and facility virtual visits via audio-only.

In-person services not rendered in an office or facility setting are not eligible for virtual reimbursement under this policy.

Coverage criteria (partial)

Key coverage positions and state exemptions noted in this portion of the policy:

All Virtual Visits performed by professional providers are subject to non-office reimbursement; professional audio-only and professional asynchronous services are included as reimbursable professional modalities.

Facility virtual visits billed on a UB04 via live audio-video are non-reimbursable for services that are not Behavioral Health; facility audio-video virtual visits are allowed only for Behavioral Health services.

Facility virtual visits via audio-only billed on a UB04 are non-reimbursable unless a state-specific exemption allows otherwise.

State exemptions (examples)

Certain states have exemptions that allow office-based reimbursement for telehealth Place of Service codes or allow facility virtual visits and audio-only services in specific markets (examples called out include Colorado, Connecticut, Georgia, Indiana, Kentucky, Missouri, New Hampshire, Nevada, Ohio). Verify market-specific language for applicability.

Place of Service, Modifiers, and Coding Guidance

Place of service and modifiersmixedCovered

Place of Service 02 or 10	Telehealth place of service for synchronous audio-visual or audio-only services
Modifier 93	Synchronous Telemedicine Service Rendered Via - identifies audio-only services
Modifier FQ	Service furnished using audio-only communication technology; applies to audio-only Behavioral Health services
Modifier GQ	Via asynchronous telecommunications system (store-and-forward); required when no telehealth-specific code reported
Modifier GT / Modifier 95	Synchronous interactive audio and video telecommunication systems (95 required when no telehealth-specific code reported)
Q3014	Telehealth originating site facility fee (facility providers only)

historical modifiers and POS changesmixed

No codes listed

Authorization, Reimbursement Notes, and State Exemptions

Prior Authorization

Authorization and medical necessity

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis and the member's state of record. Follow applicable prior authorization, documentation, and medical necessity requirements for the service being provided.

Services billed must be supported in the medical record and/or office notes.
Use industry-standard CPT, HCPCS, and revenue codes on all claim submissions.

Billing Rule

Reimbursement application notes

Professional virtual visits are subject to non-office reimbursement when not otherwise exempt by state-specific rules. Facility virtual visit reimbursement follows facility billing rules and is limited in many states to behavioral health when billed on a UB-04; audio-only facility services may be allowed only where state exemptions permit.

Definitions and Terminology

inv-09: Synchronous audio-video telehealth — POS '02' or '10' and appropriate CPT/HCPCS and telehealth modifier

Place of ServiceUse POS '02' or '10' to indicate telehealth for synchronous audio‑video services

Required codesSubmit the appropriate CPT/HCPCS code as listed in Related Policies and Materials

Telehealth modifierApply the applicable telehealth/telemedicine modifier (e.g., Modifier 95/GT when no telehealth‑specific code reported)

inv-10: Synchronous audio-only telehealth — POS '02' or '10' and Modifier 93 or FQ

Place of ServiceUse POS '02' or '10' to indicate telehealth for synchronous audio‑only services

Required codesSubmit the appropriate CPT/HCPCS code (see CPT Appendix T or codes by definition)

Policy Summary

PayerEmpire Bluecross

PolicyVirtual Visits - Professional and Facility

Policy CodePolicy C-08002

Change TypeMaterial updates to reimbursable and nonreimbursable virtual visit rulesadded state exemptions

Effective DateJul 1, 2024

Next Review Date

Key ActionEnsure virtual visit claims meet authorization and medical necessity guidelines and use the correct place of service and modifiers for professional and facility billing.

SourceLink

On This Page

This policy is subject to federal and state laws and the member's benefit terms; state-specific mandates and exemptions may supersede the policy and should be applied as applicable.

Professional audio-only and asynchronous professional services may be reimbursable where allowed.
Facility live audio‑video visits generally reimbursed for behavioral health only unless a state exemption permits otherwise.
Check member state of record for Q3014 and facility service eligibility.

Note

State exemptions

Certain states have exemptions that modify how virtual visits are reimbursed (for example, allowing office-based reimbursement, permitting facility virtual visits for non‑behavioral health services, or permitting audio‑only services). Providers must consult the state-specific exemptions for rules that override the general policy.

Examples of state variations include: Colorado, Connecticut, Georgia, Indiana, Kentucky, Missouri, New Hampshire, Nevada, Ohio, and others.
Exemptions may allow office-based reimbursement, facility virtual visits for non‑behavioral health, and/or audio‑only services.
State exemptions may add or remove allowed modalities (e.g., asynchronous, audio-only) or modifier requirements.

Note

Policy applicability and update notice

This policy is subject to federal and state laws and the terms, conditions, and limitations of a member's benefits on the date of service. Reimbursement policies are periodically reviewed and may be updated; when updated, the most current policy will be published. Anthem reserves the right to recoup or recover claim payments if implementation timing requires retroactive adjustments.

Policies may be superseded by provider, state, federal, or CMS mandates.
We reserve the right to review, revise, and publish the most current policy to the website.
If there is a delay in implementation, we may recoup and/or recover payments to the effective date in accordance with the policy.

ModifierApply Modifier 93 or Modifier FQ for audio‑only services (FQ applies to audio‑only behavioral health)

inv-11: Asynchronous / Store-and-Forward — Non-real-time communications using Modifier GQ and appropriate codes

ScopeMember‑to‑provider or provider‑to‑provider non‑real‑time communications (asynchronous)

Place of ServiceWhen member‑to‑provider, use POS '02' or '10'; when provider‑to‑provider, use POS appropriate to billing provider location

ModifierApply Modifier GQ for asynchronous/store‑and‑forward communications when no telehealth‑specific code reported

inv-12: Remote Patient Monitoring — Monitoring services billed with appropriate CPT/HCPCS and POS for billing provider location

Place of ServiceUse the place of service appropriate to the location of the billing provider for remote patient monitoring services

Required codesBill the appropriate CPT/HCPCS codes for remote patient monitoring per Related Coding

Clinical contextMonitoring services support treatment management and are subject to the policy's professional/facility reimbursement rules

inv-13: Originating Site Fee — HCPCS Q3014 billed for facility originating site when member is physically present at the originating facility

HCPCS codeUse HCPCS Q3014 for the telehealth originating site facility fee

EligibilityOriginating site fee is allowed for facility providers only

Member presenceMember must be physically present in the originating facility when Q3014 is billed

inv-14: Distant Site — Definition of distant site (provider location during telecommunication-based service)

DefinitionDistant Site = The site where the physician or practitioner providing the professional service is located at the time the service is provided via a telecommunications system.

ContextApplies to professional providers delivering services remotely to the member at the originating site.

Use in billingDistant site providers submit professional claims with appropriate POS, CPT/HCPCS, and telehealth modifiers.

inv-15: Originating Site — Definition of originating site (member location at time of service)

DefinitionOriginating Site = The location of the member at the time the service is furnished via a telecommunications system.

Billing noteWhen the member is physically present at a facility originating site, facility providers may bill Q3014 for the originating site fee.

Place of serviceUse the appropriate POS code for the provider rendering in‑person services to the member at the originating site.

inv-16: Store and Forward — Definition and scope

DefinitionStore and Forward = Transmission of a member's medical information from an originating site to the physician or practitioner at the distant site for review without the member being present.

Use casesTypically used for provider‑to‑provider interprofessional consultations; bill with appropriate interprofessional CPT/HCPCS codes and Modifier GQ.

POS guidancePlace of service is appropriate to the location of the billing provider for provider‑to‑provider store‑and‑forward services.

inv-17: Telehealth/Telemedicine — Definition: interactive telecommunications with two-way real-time audio and video

DefinitionTelehealth/Telemedicine = Use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two‑way, real‑time interactive communication between the patient and the physician or practitioner at the distant site.

Synchronous requirementTelehealth per this definition requires real‑time audio and video for interactive services.

BillingSynchronous telehealth services should be billed with POS '02' or '10' and the applicable telehealth modifier or telehealth‑specific code.

inv-18: Virtual Visits — Broad definition including telehealth, e-visits, virtual check-ins, telephone visits, and remote patient monitoring

DefinitionVirtual Visits = Technology‑based services including telehealth/telemedicine, e‑visits, virtual check‑ins, telephone visits, and remote patient monitoring.

ScopeEncompasses synchronous audio‑video, synchronous audio‑only, asynchronous/store‑and‑forward, e‑visits, virtual check‑ins, telephone visits, and remote monitoring as defined in the policy.

Reimbursement noteProfessional virtual visits are eligible for non‑office POS reimbursement when rendered at the distant site by professional providers.

inv-19: Remote Patient Monitoring/Remote Physiologic Monitoring — Definition for treatment management via live interactive communication or store-and-forward

DefinitionRemote Patient Monitoring/Remote Physiologic Monitoring = Treatment management services provided by medical professionals to manage a patient under a specific treatment plan via live interactive communication or store‑and‑forward through a medical device defined by the FDA and ordered by a clinician.

Billing guidanceBill appropriate CPT/HCPCS codes with POS corresponding to the billing provider's location.

Clinical intentUsed to support ongoing treatment management rather than non‑direct member services excluded by the policy.

inv-20: Anthem trade-name and licensing — Corporate/legal notice about trade name and affiliated entities

Trade nameAnthem Blue Cross and Blue Shield is the trade name used by multiple affiliated entities in various states; licensing and underwriting responsibilities vary by state.

State listingsThe policy lists specific entities by state (examples include Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, Virginia, Wisconsin).

Trademark noticeAnthem is a registered trademark of Anthem Insurance Companies, Inc.

inv-21: Copyright/reuse restriction — Reproduction restrictions and copyright years

Reproduction restrictionNo part of this publication may be reproduced, stored, or transmitted in any form or by any means without permission from Anthem Blue Cross and Blue Shield.

Contact for permissionPermission must be obtained from Anthem Blue Cross and Blue Shield prior to reuse or distribution.