A.   Expanded coverage of COVID-19-related services for telehealth and testing is effective March 1 through the end of the emergency declaration. Expanded coverage for treatment, early prescription refills and DME supplies is effective March 1 through June 30, 2020. Please visit Expanded Coverage for Members for more information.

A.   If you are NOT sending the test elsewhere, follow lab test Billing and Coding Guidelines. 

A.   Yes, if you ARE sending the test elsewhere to be run (i.e. state lab), follow lab test Billing and Coding Guidelines.  

A.   No, however, you can bill the collection fee. Refer to Billing and Coding Guidelines. 

A.   Follow CDC diagnosis coding guidelines or refer to Billing and Coding Guidelines.

https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf

A.   To ensure appropriate claims processing, please use the following modifiers:   

• 32, CR, or CS for the office visit and COVID-19 test
• Use condition code DR on institutional claims

A.   Yes, claims submitted on a UB-04 need to append the Condition Code “DR” based on the Billing and Coding Guidelines.

A.   Yes, at this time only COVID-19 related inpatient hospitalization precertification will be waived.

A.   Possibly. We are waiving this requirement for the following:

• Graduate Registered Nurse Anesthetists
• Post-doctoral Psychology Resident
• Psychiatry resident in psychotherapy training under the direct supervision of a psychologist

All others must still have a supervising provider in the office suite. 

A.   Not currently. We have worked proactively to prevent service disruptions or delays for members and providers. 

A.    No.

All cost-shares will be waived for telehealth services for fully insured and FEP membership during the COVID-19 emergency period. However, for self-funded accounts, cost shares are waived only for COVID-19 testing and the related office visit.

BCBSND will work with self-funded clients for potential employee coverage expansion.

If a COVID-19 test is ordered as a result of a telehealth visit, please append with the following modifiers

• 32, CR, or CS on the office visit and test
• Append condition code DR to facility claims to indicate the service delivered was COVID-19 related

A.   When using Availity, this information can be found via the eligibility response under “Funding Type.”

A.   No. Expanded coverage does not apply to deferable elective care, chiropractic care, dental care and acupuncture per the Governor’s Executive Order 2020-05.1 and the NDIC’s bulletin 2020-3.

Refer to the Billing and Coding Guidelines, Reimbursement Telehealth Policy, or Medical Policy for more information. 

A.   Many telehealth services (indicated by place of service 02) have a site-of-service differential, so reimbursement may be less when provided via telehealth.

Rates associated with codes and corresponding site of service differentials are only available through the fee schedule portal. If you have not registered for access to the portal, register at www.bcbsnd.com/FeeSchedules. For questions regarding fee schedules, please email feeschedules@bcbsnd.com.

A.   Possibly.

• When providing services out of your affiliated billing location, no changes are necessary.
• When providing services out of a location not affiliated with your profile, it must be added in order to submit claims. Please utilize the following form: Add a Location.
• If you opt to temporarily perform services from your own home rather than your office, you will not need to add your home address to your profile. Claims should be submitted as if in the main practice location.
• When utilizing providers outside of the BCBSND service area, there are separate billing requirements. Please contact prov.partners@bcbsnd.com for more information. 

A.   Yes, per CMS guidance, the HHS Office for Civil Rights (OCR) announced on March 17 it will waive potential HIPAA penalties for good faith use of telehealth during the nationwide COVID-19 public health emergency.

• Get more information https://www.hhs.gov/sites/default/files/hipaa-and-covid-19-limited-hipaa-waiver-bulletin-508.pdf

A.   Yes, provided that all the components of the applicable CPT or HCPCS codes are met (ex. 99441).

A.   Digital or e-visit codes should be used for patient-initiated contact and the appointment was not scheduled prior to the visit (example: an urgent care visit initiated through the provider portal).

E&M codes should be used when the patient had an appointment and is electing to have the visit at home to prevent exposure.

A.   Yes. The patient can opt to be at home to complete the telehealth visit. 

• CARES Act Provider Relief Fund - https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html
• Grant Opportunities & Guidance - https://www.hhs.gov/coronavirus/grants/index.html
• Federal Communications Commission (FCC): COVID-19 Telehealth Program Funding - to learn more about eligibility and to submit an application, visit fcc.gov/covid19telehealth; Frequently Asked Questions https://www.fcc.gov/covid-19-telehealth-program-frequently-asked-questions-faqs               
• CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers - https://www.cms.gov/newsroom/press-releases/cms-approves-approximately-34-billion-providers-acceleratedadvance-payment-program-medicare
• Rural Health Services Outreach Program - https://www.grants.gov/web/grants/search-grants.html?keywords=HRSA

A.   Members should contact Member Services at BCBSND using the phone number on the back of the member’s ID card.