CORONAVIRUS (COVID-19)

Resources on COVID-19 and how BCBSND is responding to help protect all North Dakotans

COVID-19 Telehealth Expansion

Given the urgency, BCBSND wants to provide telehealth guidance in a timely manner. Within the last hour, we have received additional guidance from CMS. Ensuring consistency and alignment is important to us therefore we will review and provide additional and timely updates.

Given the nature of the COVID-19 outbreak, seeking in-person medical care may lead to further spreading of the virus. BCBSND has encouraged the use of telehealth. As part of BCBSND’s commitment, BCBSND has further expanded telehealth services to all products effective March 16, 2020. A significant majority of products have already instituted this expanded set of telehealth services, but to reduce confusion and create consistency all products will have the expanded telehealth benefit during the COVID-19 pandemic.

The expanded telehealth benefit includes video visits from local participating providers and AmWell. BCBSND’s reimbursement and medical policies on telehealth continue to be a guide for the provider community on requirements and how to bill for these services.

Reimbursement Policy: https://www.bcbsnd.com/providers/policies-precertification/reimbursement-policy/telehealth-services

Medical Policy: https://www.bcbsnd.com/providers/policies-precertification/medical-policy/telehealth

Common Questions

1.      Does this include all services, even therapy and office visits?

Yes, in an effort to minimize exposure many providers are offering digital visits for established patients. Digital visits are subject to the member’s regular benefits and the applicable medical and reimbursement policy.

We expect a variety of services to be offered through digital visits. These services may include, but are not limited to the following:

  • Office visits for established patients
  • Physical therapy (PT) plan evaluation
  • Occupational therapy (OT) plan evaluation
  • Speech therapy (ST) plan evaluation
  • Behavioral health and substance use disorder treatment
  • Diabetes education
  • Nutrition counseling

2.      Will reimbursement for digital visits where the patient is at home be the same as an in-person visit?

No, per the reimbursement policy online digital visit codes have a different rate than the typical Evaluation and Management (E&M) codes that would be utilized for in-person visits.

Online Digital E&M Services for an established patient by a Physician or Qualified Healthcare Practitioner (QHP) must represent time spent during the cumulative seven days:

  • CPT 99421 [5-10 Minutes]
  • CPT 99422 [11-20 Minutes]
  • CPT 99423 [21 or more minutes]
  • 95 Modifier [Synchronous Telemedicine Service]
  • POS – 02 [Telehealth]

Online Lactation Counseling:

  • HCPCS S9443 [Lactation Class]
  • 95 Modifier [Synchronous Telemedicine Service]
  • POS – 02 [Telehealth]

Online Digital E&M Services for an established patient by a qualified non-physician professional healthcare professional (e.g. but not limited to, Social Worker, Physical Therapist, Occupational Therapist, Licensed Addiction Counselor). Code selected must represent time spent during the cumulative seven days. Providers may use either the CPT or HCPCS code, but only one code may be used.

  • CPT/HCPCS 98970/G2061 [5-10 Minutes]
  • CPT/HCPCS 98971/G2062 [11-20 Minutes]
  • CPT/HCPCS 98972/G2063 [21 or more minutes]
  • 95 Modifier [Synchronous Telemedicine Service]
  • POS – 02 [Telehealth]

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

3.      Do participating providers need anything additional to get set up to provide telehealth services?

Possibly.

  • When providing services out of provider’s affiliated billing location, they will only refer to BCBSND reimbursement policy.
  • When providing services out of a location that is not currently affiliated to the provider, the location must be added to provider profile in order to submit claims.
  • When utilizing providers outside of the BCBSND service area there are separate billing requirements. Providers are encouraged to email specific telehealth questions to prov.partners@bcbsnd.com.

4.      Can providers utilize FaceTime to perform services?

Telehealth visits must be conducted through a secure online provider portal/internet site that is HIPAA compliant and encrypted. There are many HIPAA compliant vendors available and providers will need to verify compliance, and which would best suit their practice.

5.      Does this include phone conversations with patients?

No, to qualify as a professional service, visual (face-to-face) interaction must be maintained between the health care provider and patient.

6.      Is all cost-share waived during this time?

No, only the services pertaining to testing of COVID-19 waive cost-shares. Visits regarding other medical diagnosis (i.e. psychological, substance abuse services, PT, OT, ST, etc) will continue to apply normal benefit cost sharing amounts.

As communicated previously, if a telehealth visit results in the ordering of the COVID-19 test, please append modifier 32 to indicate the service delivered was related to COVID-19.

Please contact prov.partners@bcbsnd.com with any questions about telehealth and/or COVID-19.