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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 17, 2020

CPT Code 86413 Added to Testing Codes

CPT code 86413 has been added to the list of approved codes related to testing. Refer to our COVID-19 Testing page for a complete list of approved testing and specimen collection codes.

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.

September 2, 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 to December 1, 2020.

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

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.

August 4, 2020

Updated: Codes Not Subject to EAPG Pricing

CPT codes 87426 and 0224U and HCPCS code G2024 have been added to the list of codes not subject to EAPG pricing on our COVID-19 Testing page. 

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.

July 28, 2020

CPT Code 99211 Added to Specimen Collection Codes

CPT code 99211 has been added to the list of approved codes related to specimen collection. Refer to our COVID-19 Testing page for a complete list of approved testing and specimen collection codes and fees.

July 24, 2020

Update: COVID-19 Testing Code 87426

We are adding CPT code 87426 to the Preferred Medical Doctor (PMD) Agreement - Exhibit I (Physician In-Office Laboratory Procedures). We will reprocess claims submitted with this code going back to the code's effective date of June 25, 2020. Refer to our COVID-19 Testing page for a full list of approved testing and specimen collection codes and fees.

July 20, 2020

COVID-19 Testing Code 0224U Added

CPT code 0224U has been added to the list of approved COVID-19 testing procedure codes. Refer to our COVID-19 Testing page for a full list of approved testing and specimen collection codes and fees.

July 16, 2020

Important Telehealth Coverage Update

In response to the ongoing COVID-19 pandemic, we have extended our telehealth services through December 31, 2020. We will continue to evaluate to determine whether a further extension is needed.

Telehealth services for Blue Advantage^® will continue through the Public Health Emergency, which the U.S. Department of Health and Human Services extended for 90 days effective July 25, 2020.

Please note that for most Blue Cross members, the cost-sharing waiver for telehealth services filed with a non-COVID-19-related diagnosis code will end July 31, 2020.

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.

Click here to see How to View COVID-19 and Telehealth Benefits on ProviderAccess.

July 16, 2020

Fee Increased for COVID-19 Testing Code 87426

The fee for COVID-19 testing CPT code 87426 has been increased to $31.02. We will reprocess claims submitted with this code going back to the code's effective date of June 25, 2020. Refer to our COVID-19 Testing page for a full list of approved testing and specimen collection codes and fees.