CurrentEmpire BluecrossPolicy C-08002

Virtual Visits — Professional and Facility Reimbursement

Defines reimbursement for professional and facility virtual visits including telehealth, audio-only, asynchronous, and remote monitoring; applies to Anthem Blue Cross and Blue Shield markets with state-specific exemptions.

Policy Summary

PayerEmpire Bluecross

PolicyVirtual Visits — Professional and Facility Reimbursement

Policy CodePolicy N/A

Change TypeRevised / Added / Clarified

Effective Date07/01/2024

Next Review Date

Key ActionSubmit professional virtual visit claims for non-office place of service; facility live audio-video reimbursed only for Behavioral Health.

SourceLink

POLICY UPDATE CHANGES

Removed Maine exemption and updated language to state all Virtual Visits performed by professional providers will be subject to non-office reimbursement; added definitions for Asynchronous and Synchronous; updated Reimbursable section; added professional audio only services; added professional asynchronous services; clarified facility audio-video services are allowed for Behavioral Health only.

Added professional asynchronous services and professional audio only services.

Clarified facility audio-video services are allowed for Behavioral Health only; added Facility Virtual Visits via live audio-video for non-Behavioral Health billed on a UB04 as nonreimbursable.

Regulatory-driven additions/removals of state-specific exemptions (e.g., Connecticut, Colorado, Nevada, Ohio, New Hampshire, Kentucky).

03/29/2024last review

09/01/2024referenced effective

multiplestate exemptions

Policy Summary

PayerEmpire Bluecross

PolicyVirtual Visits — Professional and Facility Reimbursement

Policy CodePolicy N/A

Change TypeRevised / Added / Clarified

Effective Date07/01/2024

Next Review Date

Key ActionSubmit professional virtual visit claims for non-office place of service; facility live audio-video reimbursed only for Behavioral Health.

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.

Coverage stance and state exemptions

Reimbursement varies by modality and by state. Professional virtual visits are generally treated as non‑office reimbursement; state exemptions modify Place of Service and modifier treatment.

ALL of the following

All Virtual Visits performed by professional providers are subject to non-office reimbursement unless a state-specific exemption applies.
Exceptions — state-specific exemptions
- States with exemptions have modified Place of Service (POS) treatment (examples in policy history include Connecticut, Colorado, Georgia, Indiana, Kentucky, New Hampshire, Nevada).
- Certain states permit office-based reimbursement for POS 02 and/or 10 (example: Connecticut exemption referenced in history).
- Some states allow facility virtual visits for non‑Behavioral Health and audio‑only services as exemptions (examples noted: Colorado, Kentucky, Nevada, New Hampshire, Indiana).
- Ohio policy history reflects removal of some exemptions and allowance for reimbursement of asynchronous transmission by audio‑only telephone communication, facsimile, e‑mail, instant messaging and other electronic communication.
Facility live audio‑video services are reimbursable only for Behavioral Health; Facility live audio‑video for non‑Behavioral Health billed on a UB04 is treated as non‑reimbursable except where a state exemption permits otherwise.
Added professional modalities (per 03/29/2024 revision)
- Professional audio‑only services were added as reimbursable in the professional scope.
- Professional asynchronous (store‑and‑forward) services were added as reimbursable in the professional scope.

Coding, Modifiers, and Place of Service

Telehealth / Virtual Visit ModifiersModifier

93	Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system (as defined by payer/state). Added to policy history 04/13/2022.
FQ	FQ modifier — service delivered via asynchronous telemedicine (store and forward) when permitted by state/regulatory mandate.
GQ	Asynchronous telemedicine service (via store-and-forward). Historically referenced in policy; some state exemptions removed per policy history.
GT	Interactive audio and video telecommunication used to surmount geographic barriers — synchronous telehealth modifier. Policy history notes updates and reductions related to GT and Modifier 95.
95	Synchronous telemedicine service rendered via interactive audio and video telecommunication systems. Added effective 01/01/2017; referenced in multiple policy history entries.

POS office-based reimbursement exemptions — Place of Service (02) and (10) treatment varies by state per exemptions

Place of Service (POS) office-based reimbursement exemptionsPlace of Service (02) and (10) treatment varies by state per exemptions. Historical policy edits: Connecticut exemption removed 09/19/2023 (02 and 10 now eligible for non-office reimbursement effective 01/01/2024); Connecticut, Georgia, Nevada, New Hampshire, Colorado and other states have had exemptions added or removed over time. Review state-specific regulatory guidance before billing.

Reimbursement treatment and state-specific provider actions

Billing Rule

Reimbursement treatment for professional and facility virtual visits

Professional virtual visits (services rendered by professional providers) are subject to non-office reimbursement unless a state-specific exemption applies. Facility virtual visits via live audio-video are reimbursable only for Behavioral Health services; facility virtual visits for non-Behavioral Health are billed on UB-04 and are non-reimbursable unless a state exemption permits otherwise. Providers must apply state-specific Place of Service and modifier rules where exemptions exist.

Professional virtual visits now subject to non-office reimbursement (unless state exemption applies)
Facility live audio-video allowed for Behavioral Health only; non-BH facility services billed on UB-04 are non-reimbursable unless state exemption permits
Professional audio-only and asynchronous professional services were added to reimbursable definitions where allowed

Note

Key definitions

Distant Site

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.

RoleLocation of the clinician delivering care remotely (telehealth provider location).

RelevanceUsed to determine billing/provider location for professional virtual visit services per policy definitions.

Originating Site

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

RoleMember location at time of telecommunication-based service (where the patient is situated).

State-specific exemption actions

State-specific exemptions modify reimbursement treatment (Place of Service and modifier application). Providers must follow the latest state directives for exemptions which may allow office-based reimbursement (POS 02 or 10) or permit additional modalities (audio-only, asynchronous) and modifier use.

Connecticut: has had exemptions added/removed over time — when exempt, virtual visits may be eligible for office reimbursement; check effective dates for applicability
Colorado: exemption added effective 01/01/2022 (POS considerations)
Maine: exemption removed as of 03/29/2024 (no longer exempt)
Nevada: exemptions added/removed historically — some updates allowed facility virtual visits for non-BH and audio-only services
New Hampshire: added exemption allowing facility virtual visits for non-BH and audio-only services (and updates allowing office-based reimbursement)
Ohio: removed exemptions that previously disallowed asynchronous transmission by audio-only telephone, facsimile, e-mail, instant messaging and other electronic communication (check current status)
Kentucky: exemption added previously allowing POS Telehealth (02) and (10) to be eligible for office-based reimbursement

RelevanceDetermines originating-site considerations for reimbursement and state exemption applicability.

Remote Patient Monitoring / Remote Physiologic Monitoring

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 physician or other qualified health care professional.

ModalitiesMay be delivered via live interactive communication or store-and-forward using FDA-defined medical devices.

Use caseApplies when clinicians manage patients under a specific treatment plan remotely as described in policy definitions.

Store and Forward

DefinitionStore and Forward — the transmission of a member's medical information from an originating site to the physician or practitioner at the distant site; the distant-site clinician can review the medical case without the member being present.

FunctionEnables asynchronous review of patient data by the distant-site provider.

ExamplesIncludes sending images, records, or other medical information for later review per policy definitions.

Telehealth / Telemedicine

DefinitionTelehealth / Telemedicine — the 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.

RequirementsMinimum of audio and video equipment to permit two-way, real-time interaction.

ScopeConsidered a form of Virtual Visit under the policy definitions.

Virtual Visits

DefinitionVirtual Visits — technology-based services including telehealth/telemedicine services, e-visits, virtual check-ins, telephone visits, and remote patient monitoring.

ScopeEncompasses synchronous and asynchronous modalities and audio-only or audiovisual encounters as defined in the policy.

Policy relevanceAll Virtual Visits performed by professional providers are subject to the reimbursement treatment described in the policy (see policy history for state-specific exemptions).