CORONAVIRUS (COVID-19)

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

COVID-19 Telehealth Expansion Update

The safety and security of our members – and of all North Dakotans – remains the top priority during these unprecedented times. Blue Cross Blue Shield of North Dakota (BCBSND) remains committed to ensuring members can connect with providers.

BCBSND has thoroughly reviewed the guidance set forward on March 17th by the Centers for Medicare & Medicaid Services (CMS). This guidance from CMS is in alignment with what will be considered allowable for BCBSND members, on a temporary basis (during the declared COVID-19 emergency period). These changes are effective March 16, 2020.

In addition, BCBSND and the Blue Shield Federal Employee Program® (FEP®) has decided to waive cost-sharing for all telehealth services for fully-insured members. BCBSND will work with self-funded clients related to further expanded coverage for their employees.

The following is applicable during the COVID-19 emergency period:

Type of Service

What is the Service

HCPCS/CPT Code

Patient Relationship with Practitioner

Telehealth visit

Visit with a provider that uses a telecommunication system connecting the patient with the provider.

· 99201-99215

· G0425-G0427

· G0406-G0408

New or established patients

Virtual Check-In

A brief communication via telephone or other telecommunication device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.

· 99441-99443

· G2012

· G2010

For established patients

Digital Telehealth (E-visits)

Digital communication initiated by the member to a provider through the provider’s online patient portal.

· 99421-99423

· 98970-98972

· G2061-G2063

*During the COVID-19 emergency period only, providers must use modifier 95 when reporting face-to-face or non-face-to-face digital visits to ensure correct claims processing.

For established patients

CMS guidance can be found here: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Given BCBSND’s alignment with CMS, the common questions from the last communication have been updated. Please review as information has changed.

 

Common Questions

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

Yes, in an effort to minimize exposure, many providers are offering telehealth options. Telehealth visits are subject to the member’s regular benefits.

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

  • Office visits for 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

For services outside of E&M visits and telemedicine/digital visits, providers should use the appropriate CPT or HCPCS code and applicable modifier for the services rendered, if the services meet all criteria of the services rendered. Provider should submit Place of Service 02 if the provider is rendering services through a telehealth communication system.

 

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

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, 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, no changes should be needed.
  • When providing services out of a location that is not currently affiliated to the provider, the location must be added to the provider’s profile in order to submit claims.
  • If providers opt to perform services from their own home temporarily, rather than their office/billing location, providers will not need to add their home address to their profile. Claims should be submitted as if the provider was in their main practice location.
  • 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/Facebook/Skype to perform services?

Yes, per CMS guidance, the HHS Office for Civil Rights (OCR) announced on March 17, 2020, that it will waive potential HIPAA penalties for good faith use of telehealth during the nationwide public health emergency due to COVID-19. Further information is available: https://www.hhs.gov/sites/default/files/hipaa-and-covid-19-limited-hipaa-waiver-bulletin-508.pdf

 

5. Does this include phone conversations with patients?

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

 

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

Yes, all cost-shares will be waived for telehealth services for our fully-insured and FEP membership during the COVID-19 emergency period. However, for self-funded accounts the waiving of cost shares only applies to those services pertaining to the testing of COVID-19.

Visits regarding other medical diagnosis (i.e. psychological, substance abuse services, PT, OT, ST, etc) will continue to apply normal benefit cost sharing amounts. BCBSND will work with self-funded clients related to further expanded coverage for their employees.

As communicated previously, if a telehealth visit results in the ordering of the COVID-19 test, please append modifier 32 or CR on professional claims. On facility claims, please utilize condition code DR per CMS guidance to indicate the service delivered was related to COVID-19.

 

7. When should I use an e-visit or digital code versus an E&M code?

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’s 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.

 

Billing for Services and Supplies During the COVID-19 Public Health Emergency

Blue Cross Blue Shield of North Dakota (BCBSND) has received inquiries from providers and suppliers related to services and supplies furnished to BCBSND members during the COVID-19 Public Health Emergency.

BCBSND encourages providers and suppliers to follow CDC guidelines when coding encounters related to COVID-19. https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

BCBSND also requests modifier CR be appended to claims meeting the following conditions:

  • DME supplies and items furnished to BCBSND members outside of the normal quantity and frequency limits
  • Services and encounters related to treatment or testing of COVID-19

Providers and suppliers can read more on how BCBSND is responding to COVID-19 to help protect the health of our member at https://www.bcbsnd.com/newscenter/health-wellness/-how-bcbsnd-is-responding-to-coronavirus-to-help-protect-the--he

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