COVID-19 Vaccines and Administrations

Blue Cross Blue Shield of North Dakota (BCBSND) is committed to keeping providers informed of the billing and coding guidelines for the COVID-19 vaccines and administration. As the vaccines arrive in North Dakota, we project changes to billing and coding over the next several weeks based on Government and State regulations. Visit our website under our Provider COVID-19 webpage for the most current COVID-19 vaccine and administration related information.

COVID-19 Extended Coverage Update

BCBSND is extending services for COVID-19 treatment, prescriptions refill, DME supplies and the wavier of precertification of authorizations for post-care/alternative care until March 31, 2021. COVID-19 testing and telehealth expanded services will continue through the end of the emergency declaration. As a reminder, all services are reviewed based on medical necessity and appropriateness and are not guaranteed for payment. For Federal Employee Programs (FEP) and out-of- state guidelines, please contact those plans.

COVID-19 Billing and Coding Guideline Reminders

BCBSND has seen an increase in appeals related to COVID-19 with coding guidelines not being followed. Listed below are some examples:

  • Provider is billing for an E/M service without appending the appropriate modifier to indicate service was related to COVID-19, therefore service applied towards benefits and applied cost share
    • In order to indicate E/M service is related to COVID-19, one of the appropriate COVID-19 related modifiers is necessary. Append one of the following, CS, CR or 32 this will allow the service to waive cost share
      • To correct the claim, providers are required to do a frequency 8 (VOID) and the claim will need to be resubmitted as a new claim
  • Telehealth services are not allowed to be billed on the same day as an E/M service when the services are not separately identifiable
    • In order to indicate that services are separately identifiable an appropriate modifier is needed
      • All services are reviewed based on medical necessity and appropriateness and are not guaranteed for payment

For the most current COVID-19 related updates, visit our website at https://www.BCBSND.com/coronavirus/covid-19providers.