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COVID-19 Telehealth: Frequently Asked Questions

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 two sections: Blue Advantage and other contracts. 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 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. For Alabama Blue Cross members, the claim should be filed with a place of service 02 (zero two) 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?

In some cases, cost sharing may be waived based on regulatory guidance from the Coronavirus Aid, Relief and Economic Security (CARES) Act or the Families First Coronavirus Response Act. Cost sharing will be waived for all members for:

  • COVID-19 diagnostic test
  • Office, urgent care, emergency room, behavioral health and telehealth visits for COVID-19

Some members may also have waived cost sharing for non-COVID telehealth visits and/or inpatient cost sharing (related to COVID), depending on their contract. Therefore, in order to best serve our members, please check eligibility and benefits for each patient to ensure which cost sharing is waived under his/her plan.

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

In response to the COVID-19 public health emergency, Blue Cross has approved these codes to be performed via telehealth at this time.

For services provided to Blue Advantage members, there is an audio and visual requirement, effective April 21, 2020. For other plans, these services may be performed with or without video. 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?

We have provided a reference article that explains these terms on our website. This article explains how Blue Cross and Blue Shield of Alabama references 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 the COVID-19 Coding Guide.

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.