Expanded coverage of COVID-19-related services for telehealth and testing is effective March 1 through the end of the emergency declaration. Please visit Expanded Coverage for Members for more information.

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

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

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

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

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

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

 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. 

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

No. Cost-share waivers apply for telehealth services for fully insured and FEP members only.

Cost-share waivers apply for all members for COVID-19 testing.

Please see the Billing and Coding Guidelines for details.

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

No. Expanded coverage does not apply to deferable elective care, chiropractic care, dental care and acupuncture.

Refer to the Billing and Coding Guidelines for more information.

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.

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. 

Yes, per CMS guidance, HIPAA penalties will be waived for good faith use of telehealth during the nationwide COVID-19 public health emergency.

Read more information on the Health and Human Services HIPAA Waiver Bulletin.

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

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.

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

- Accelerated/Advance Payment Program for Medicare Providers
- CARES Act Provider Relief Fund
- Distance Learning & Telemedicine Grants
- Grant Opportunities & Guidance
- Federal Communications Commission (FCC): COVID-19 Telehealth Program Funding
- Federal Communications Commission (FCC) Telehealth Program Frequently Asked Questions 
- Rural Health Services Outreach Program

Members are encouraged to visit www.bcbsnd.com/COVID-19 for more information. They are also encouraged to contact Member Services by calling the phone number of the back of their Member ID card.