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Back to Telehealth Coverage Guidelines

Information on this page is effective during the federal public health emergency (PHE) related to COVID-19. The PHE expired on May 11, 2023.

Q: Is my specialty eligible for performing telehealth?

The Telehealth Billing Guide contains a list of approved CPT codes and providers eligible to bill for them under our expanded Telehealth Coverage Guidelines for COVID-19.

For services provided to Blue Advantage^® patients, the full list of approved telehealth codes is available through a link to the CMS webpage contained in our Telehealth Billing Guide. For these codes, we have not listed each eligible provider type - providers who would normally perform the service and bill Blue Cross may do so for telehealth.

Q: Which codes are covered by Blue Cross? Does this include Blue Advantage?

The Telehealth Billing Guide contains a list of approved CPT codes for our expanded Telehealth Coverage Guidelines. The guide contains multiple sections. Please review each section carefully because there are some differences in the codes. If a code is not listed in the guide, it is NOT included at the time of the publication. This guide updates frequently as the current COVID-19 Public Health Emergency evolves. Please continue to check AlabamaBlue.com/providers/coronavirus for the most up-to-date version.

Q: Does Blue Cross require modifiers for telehealth (95/GT/GQ) or disaster/crisis (CR)?

At this time, Blue Cross and Blue Shield of Alabama does not require the use of a modifier to indicate telehealth or disaster/crisis. However, Blue Cross and Blue Shield Federal Employee Program^® (BCBS FEP) uses modifiers for certain telehealth claims. For Alabama Blue Cross members, the claim should be filed with a place-of-service code to indicate the service was rendered via telehealth. While this is the claims-filing process for Blue Cross and Blue Shield of Alabama, this may vary among payers.

Q: Is Blue Cross waiving cost sharing for all members? Does this apply to all services?

Blue Cross and Blue Shield Plans nationwide are implementing various types of cost-sharing waivers as a result of COVID-19. Always check eligibility and benefits through ProviderAccess or your practice management system to confirm coverage and cost-sharing details. 

View our COVID-19 and Telehealth Benefits Guide

Q: Are the evaluation and management codes (9921X, 9920X) the correct codes to use for telehealth?

As of October 1, 2022, for Commercial members, these codes should only be reported if the evaluation and management service contains both audio and visual components. CPT codes 99441-99443 should be reported for audio-only evaluation and management services. 

For services provided to Blue Advantage members, there is an audio and visual requirement, effective April 21, 2020. Please refer to the Telehealth Billing Guide for eligible providers.

Q: Is there coverage of behavioral health services provided via telehealth?

Behavioral health is included with our telehealth expansion. The Telehealth Billing Guide includes a link to the New Directions Behavioral Health telehealth policy.

Q: What is the difference between telehealth and telemedicine?

See "Explained: Telehealth vs. Telemedicine" for an explanation of how Blue Cross and Blue Shield of Alabama defines these terms. Other payers, such as CMS, may refer to these terms more broadly or even interchangeably.

Q: Are there frequency limits for billing telehealth visits?

Some of the approved codes may have defined frequency limits. If the code has a defined frequency limit, it is noted in the Telehealth Billing Guide. Telehealth services should be treated the same way as a face-to-face service when considering frequency and appropriate use.

Q: What if a patient calls for telehealth and then needs to be seen by the same provider or referred to another provider for a test or follow-up the same day?

More than one in-network office, urgent care, emergency room or behavioral health visit, or telehealth service for the same member incurred on the same day will be covered if it is rendered by in-network PPO providers and the claims are filed with a COVID-19 related diagnosis as outlined by the CDC and American Medical Association.

Q: Is Blue Cross reimbursing for specimen collection fees (CMS codes G2023/G2024)?

For billing guidance regarding COVID-19 tests and associated lab billing codes, please refer to our COVID-19 Testing page.

Q: Is there more information on how/when to use diagnosis code U07.1 for the novel coronavirus?

For a complete list of diagnosis coding guidance for confirmed, suspected, or asymptomatic cases, please refer to the CDC’s guidelines: ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020.