Due to the COVID-19 pandemic, BlueCross BlueShield of South Carolina and its subsidiary BlueChoice® HealthPlan have been working diligently and actively to ensure the provider community is abreast of pertinent information that will allow continuous, uninterrupted service. In response to current updates on COVID-19, modifications have been made to some of the existing changes that were established.
General Coverage –
BlueCross and BlueChoice are covering medically necessary diagnostic tests and related services (such as office visits, urgent care and ER visits) that are consistent with CDC guidelines related to COVID-19 at no cost share to the member.
NOTE: Self-insured plan sponsors have the option to opt out of waiving member cost shares.
Serology (antibody) testing will only be covered when medically appropriate for an individual, as determined and ordered by their physician, after an evaluation is completed and in accordance with accepted standards of current medical practice. Serology testing should not be used solely to diagnosis the COVID-19 infection. Please refer to CAM 244 for additional details. There are two codes associated with serology testing:
- 86328 – Immunoassay for infectious agent antibody(ies), qualitative or semi quantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
- 86769 – Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
NOTE: After clicking the link to CAM 244, accept the disclaimer and search for “COVID-19 Testing”.
Billing Guidelines –
When filing claims for patients that are suspected to have encountered COVID-19, be sure to use one of the following diagnosis codes in the array diagnosis codes submitted:
- Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out
- Z20.828 – Contact with and (suspected) exposure to other viral communicable diseases
For example, if a patient comes into the office and has a cough and fever and you suspect they have been exposed to COVID-19, the claim should be submitted with diagnosis codes R05, R50.9 and Z20.828.
Telehealth Services –
BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan has extended the temporary expansion for telehealth services through October 1, 2020. Effective August 1, 2020, both plans will revert back to requiring the use of HIPAA-secured telehealth systems in which care is delivered synchronously using both audio and visual modalities in order for services to be reimbursed.
Physicians are required to enroll in the Telehealth program prior to rendering services. If you have multiple locations that need to be enrolled, only one application is required. Be sure to include the Tax IDs, all NPIs and all locations that need to be enrolled. A spreadsheet can be attached to the application if you have several locations.
NOTE: This only applies to in network, South Carolina providers.
BlueCross and BlueShield will cover telehealth for inpatient, emergency department and critical care locations.
Claims submitted for evaluation and management services, in person, reflected by the code sets 99201-99203 and 99211-99215 require a 95 modifier.
Claims submitted for evaluation and management services, by telephone, reflected by the code set 99441-99443 do not require a 95 modifier.
As of July 10, 2020, the CPT codes 99495 and 99496 have been included in the expanded telehealth coverage.
Prior Authorizations/Notifications –
Prior authorization is not required for COVID-19 related conditions and treatment, including skilled nursing facility admissions from the hospital.
BlueCross and BlueChoice will allow hospitals to manage inpatients in alternate sites of care for capacity considerations. These will require notification and include, but are not limited to, ambulatory surgery centers and outpatient centers.
BlueCross and BlueChoice will not waive the 24-hour notification rule for emergency admissions.
Place of Service 02 –
CMS has not changed the original definition, or usage of, POS 02. POS 02 is defined as a facility, inpatient or outpatient, and is only to be used when actual telemedicine services are provided through approved audio and visual communication equipment. CMS implemented the POS 02 back in 2017 to cover their limited Telehealth program. That program required the patient to travel to a site, originating site, and interact with a remote doctor, remote site. Services covered under this where limited and the communication done was both audio and visual in nature. On March 1st, 2020 CMS announced the expansion of what services could be done under Telehealth, and, also what would be allowed to be considered Telehealth. CMS did not change the original definition of POS 02, or, instruct that the usage of POS 02 should be expanded, to cover the expanded services allowed, under the expanded definition of Telehealth, during the COVID-19 national public health emergency. CMS also directed office based physicians, performing services under the new expanded Telehealth definition, to bill their usual POS code and add modifier 95 to any service being done via the expanded Telehealth definition. Thus, POS 02 should only be used when the patient travels to a site to receive actual Telemedicine services. This requires the use of approved audio/visual equipment, involves an originating site and a remote site, and will result in two claims being submitted. One for the origination sites services, and, one for the remote sites services.
Pre-payment Review –
We will revert back to normal pre-payment reviews for high dollar claims on August 31, 2020. Claims over $200,000 received on or after August 31, 2020 will follow the normal pre-payment review process. All pre-payment high dollar claims reviews require itemized bills and medical records may be requested as needed.
Review the original COVID-19 FAQs.
If you have any questions regarding the information presented in this bulletin, please contact Provider Education using the Provider Education Contact Form located on www.SouthCarolinaBlues.com or www.BlueChoiceSC.com.