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Telehealth Coverage Guidelines

Back to COVID-19 Provider Update Center

       

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
  • Facility/Hospital 
  • 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.

Documentation Tip:

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:

Use one of the following codes found on CMS' List of Telehealth Services; a link to this list is also available in our Telehealth Billing Guide:

CPT Code Description Notes
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: