Our customer contact center is currently experiencing high call volumes. We thank you for your patience.
High call volume
Our customer contact center is currently experiencing high call volumes. We thank you for your patience.
The following billing guidelines reflect the Centers for Medicare & Medicaid Services (CMS), Blue Cross Blue Shield Association (BCBSA) and North Dakota Department of Insurance State guidance. Please follow these directions to ensure proper claims processing.
The following code modifications determine how Blue Cross Blue Shield of North Dakota (BCBSND) appropriately waives cost sharing amounts as outlined in our expanded COVID-19 coverage. Not all COVID-19 related services are paid with a cost share waiver of 100%, this is based on member benefits.
Note: The collection is an inherent component of the in-person E/M visit so it should not be billed unless it’s the only service provided. Telehealth E/M visits may result in the determination of the need for a COVID-19 specimen collection. Providers must submit modifier 25 and 95 on the Telehealth E/M to support the separately identifiable Telehealth visit from the onsite clinical staff collection fee.
Refer to CMS COVID-19 Vaccines and Monoclonal Antibodies webpage for a full listing of the COVID-19 vaccine, administration and monoclonal antibodies codes, descriptions and effective dates.
Vaccine & Administration
Providers should refer to the Modifier SL – State Supplied Vaccinations Reimbursement Policy for guidelines for billing COVID-19 State Issued vaccines.
Vaccine Administration At Home
Effective June 8, 2021, CMS established a new Healthcare Common Procedure Coding System (HCPCS) code, M0201, to report for an additional payment when COVID-19 vaccines are administered to patients that have difficulties leaving their homes or are hard-to-reach. HCPCS M0201 is reported in addition to the existing product-specific COVID-19 vaccine administration codes (e.g., 0001A, 0002A, 0011A, 0012A, 0031A) when administered in the home.
Monoclonal Antibody Infusion and Administration
The U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the investigational monoclonal antibody therapy. These monoclonal antibody therapies are for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and/or hospitalization.