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December 16, 2020

Blue Cross Expands Hospital Access as COVID Cases Surge

As COVID-19 cases increase and many hospitals across the state approach peak admissions, Blue Cross and Blue Shield of Alabama is improving needed access for patients.

Effective December 17, 2020, we are streamlining admissions to long-term acute care hospitals (LTACH) for Blue Cross members with one or more specified diagnoses. These facilities offer appropriate and needed services to meet the needs of patients admitted for complex medical care.

This streamlined process for Blue Cross members, including our Blue Advantage^® Plan, extends through January 31, 2021. Visit our COVID-19 Treatment page for additional details.

December 15, 2020

Codes Available for COVID-19 Vaccines and Monoclonal Antibodies 

Codes for COVID-19 vaccines and monoclonal antibodies as well as their administration have been published on our COVID-19 Treatment page. Vaccine codes are effective after the U.S. Food and Drug Administration approves the vaccine for emergency use.

Important note about Blue Advantage^® members: Providers administering COVID-19 vaccines to Blue Advantage members must submit those claims to the CMS Medicare Administrative Contractor (MAC) for payment.

December 15, 2020

CPT Code 99072 Not Billable 

We do not reimburse providers for CPT code 99072, which is defined as: “Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.”

Code 99072 has been added to our List of Procedures and Services Not Separately Paid, which outlines CPT and HCPCS codes that are not separately payable services.

December 9, 2020

DME Update: Oxygen Therapy

In response to the ongoing COVID-19 public health emergency, the suspension of the oxygen saturation requirement for both certification and recertification has been extended through the end of the federal public health emergency.

Refer to our COVID-19 Treatment page for additional treatment information.

December 4, 2020

Important Telehealth Policy Update

In response to the ongoing COVID-19 pandemic, expanded telehealth services coverage for eligible Blue Cross members including Blue Advantage^® will continue through the end of the federal public health emergency. Continue to check our COVID-19 Provider Update Center for important announcements.

Because benefits can vary depending on a member’s plan, it’s important to always check eligibility and benefits through ProviderAccess or your practice management system to confirm coverage and cost-sharing details.

October 8, 2020

Federal Public Health Emergency Extended

The U.S. Department of Health and Human Services has extended the public health emergency in response to the COVID-19 pandemic for 90 days, effective October 23, 2020. This action includes extension of telehealth services for Blue Advantage. Refer to our Telehealth Coverage Guidelines page for more information.

September 8, 2020

Avoid Common COVID-19 Billing Issues

During our response to the COVID-19 pandemic, we have not waived standard documentation or medical necessity policies. It is important that providers review medical record documentation and avoid the following common inappropriate billing scenarios: 

• Do not bill specimen collection HCPCS code G2023 with a Level 2 or higher evaluation and management (E/M) service. The specimen collection is included with the E/M service.
• Do not bill a Level 2 or higher E/M code if the patient is not seen by a billable practitioner.
• Do not submit a claim for a telehealth visit if:
  • the phone call is part of normal practice operations (scheduling, refill request with no changes),
  • the billing practitioner does not personally speak to the patient, or
  • the minimum medical necessity and documentation requirements are not met during the call.

September 8, 2020

COVID-19 Panel Testing 

As the demand continues for COVID-19 testing, we are advising providers that panel testing should be ordered only if it is medically necessary for the patient. Routinely performing respiratory panels is not appropriate in the absence of supportive clinical symptoms. In most cases, only a specific test to determine the presence of COVID-19 is needed.

At some point in the near future, medical necessity reviews may be used to determine if panel tests given to patients were needed. Providers who order panel tests should note in the medical record the reason for such a test.

Refer All Tests to In-Network Laboratories

All Blue Cross and Blue Shield of Alabama participating providers are required per their contract to refer to in-network laboratories. A list of in-network labs is available at AlabamaBlue.com/providers/FindALab.

Review our COVID-19 Testing page for additional information, including our guidance on surveillance vs. diagnostic testing coverage.

August 14, 2020

COVID-19 Testing: Clarification on Testing for Return to College/Work

As you may be aware, COVID-19 tests are currently being required by most Alabama colleges and universities as a condition for a student’s return to campus, regardless of whether the student has any symptoms or exposure. This has created an increase in the number of patients requesting testing as well as confusion regarding coverage.

The good news is that the state of Alabama is providing testing free of charge to students through GuideSafe Entry Testing, which is being funded through Federal CARES Act funds allocated by Governor Ivey. COVID-19 testing is required for students who reside on campus for many public or private four-year colleges and all two-year colleges in the state of Alabama. For other schools, COVID-19 testing is strongly encouraged but not required. Specific testing protocols are directed by each campus. All students should receive an email explaining the program and the procedure to follow in order to register for testing. Students must follow the guidelines and register through the web link provided in the email in order for testing to be covered.

To clarify, our coverage for COVID-19 testing is outlined below:

Covered

Medically Appropriate COVID-19 Testing – Testing to detect or diagnose COVID-19 in an individual when there is presence of a potential COVID-19 symptom or actual or suspected exposure to a person with COVID-19.

Non-Covered

Surveillance COVID-19 Testing – Testing for patients to return to work or school to rule out the possibility of COVID-19 in the absence of symptoms or exposure. Federal government guidance on this legislation issued June 23, 2020, states that group health plans and insurers are not required to pay for COVID-19 tests that are ordered for surveillance purposes. This testing is covered for students through the GuideSafe Entry Testing Program. Surveillance testing is not covered for employees returning to work.

July 30, 2020

Dispensing Limits on Hydroxychloroquine, Chloroquine and Azithromycin Discontinued

Dispensing limits on these drugs will be discontinued as of August 1, 2020. For more information, see our COVID-19 Treatment page.

July 29, 2020

Attention Blue Advantage^® Providers: Use Appropriate Codes for Telehealth E/M Services

Providers must use correct codes to indicate whether audio and video equipment or audio only was used when performing evaluation and management (E/M) services via telehealth for Blue Advantage patients. Refer to our Telehealth Coverage Guidelines page for details.