Telehealth Coverage Guidelines
Updated July 16, 2020
Due to COVID-19, Blue Cross and Blue Shield of Alabama expanded telehealth services effective March 1, 2020. This expansion of services will expire on December 31, 2020. We will continue to evaluate to determine whether a further extension is needed.
For complete information, refer to our Telehealth Billing Guide. This guide details the eligible providers and services included in the telehealth coverage expansion for each of these categories:
- Blue Advantage®
- Blue Cross
- Federal Employee Program (FEP)
Only the codes listed in the Telehealth Billing Guide should be submitted for these expanded telehealth services.
Always check eligibility and benefits through ProviderAccess or your practice management system to confirm coverage and cost-sharing details for your patients.
For behavioral health billing and coding guidelines specific to this telehealth expansion, refer to the New Directions Behavioral Health telehealth expansion memo.
Blue Advantage® Telehealth Updates
Telehealth services for Blue Advantage will continue through the Public Health Emergency, which the U.S. Department of Health and Human Services has extended for 90 days effective July 25, 2020.
CMS is allowing the expansion of telehealth services to include Annual Wellness Visits for Blue Advantage patients.
Audio and Video Required for Telehealth Services
Effective April 21, 2020, Blue Advantage telehealth services require providers to use audio AND video capability for the visits.
We do understand that some patients may not have access to video equipment. In these situations, the patient's medical record encounter documentation should note that services were rendered via audio telecommunications only due to the patient not having video capabilities.
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.
When performing E/M services with AUDIO AND VIDEO:
Use traditional E/M CPT codes 99201-99205, 99211-99215 and be sure to include a statement in the medical record that audio and video were used.
If you are performing the visit using audio and video technology, documentation best practices for telehealth include noting in the medical record, at minimum:
- Patient consent
- Patient’s location
- The telehealth visit uses audio and visual components
When performing E/M telehealth services with AUDIO ONLY:
|99441||Phone e/m phys/qhp 5-10 min||Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20|
|99442||Phone e/m phys/qhp 11-20 min||Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20|
|99443||Phone e/m phys/qhp 21-30 min||Temporary Addition for the PHE for the COVID-19 Pandemic—Added 4/30/20|
If you have questions about Blue Advantage telehealth coverage, call Provider Networks at 1-866-904-4130.
Telehealth Billing Reminder: Use Approved Codes to Avoid Rejected Claims
We have noticed that some claims for telehealth services were filed with CPT codes 98966-98968 or 99441-99443. Although these are valid CPT codes, they are not included in our COVID-19 expanded Telehealth Coverage Guidelines.
If you notice a rejected claim that was originally submitted with one of the above codes, file a new claim with one of the approved codes from our Telehealth Billing Guide and place of service 02 (telehealth).
Helpful Telehealth Resources:
- Explained: Telehealth vs. Telemedicine
- "COVID-19 Telehealth Coding & Documentation Tips," April 9 Timely Topics Webinar
- Take the Exam (1 CEU)
- For information about prescribing controlled substances via telehealth, see the joint statement on the Alabama State Board of Medical Examiners website and the additional statement from the Alabama Board of Pharmacy.