FAQs for COVID-19

FAQs for COVID-19

BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan are actively monitoring the rapidly evolving international coronavirus (COVID-19) pandemic. We continuously review information and updates from trusted sources of information including the Centers for Disease Control and Prevention (CDC); World Health Organization (WHO); Centers for Medicare and Medicaid (CMS); and South Carolina Department of Health and Environmental Control (SCDHEC).

Listed below are some frequently asked questions from the provider community and the answers based on information we currently have. Please be sure to check back regularly for any updates. Please make sure your question is addressed below before you call your provider representative or our call center. This will allow our representatives to handle more specific and urgent questions as quickly as possible.

NOTE: Questions are added periodically.  Be sure to read the bulletin in its entirety to avoid missing any important information.

General Coverage Questions

1. Is BlueCross/BlueChoice waiving copayments for COVID-19 testing and treatment?
BlueCross/BlueChoice will cover medically necessary diagnostic tests and related services (such as office visits, urgent care and ER visits), that are consistent with CDC guidance related to COVID-19 at no cost share to the member. Additional coding information will be sent out in a separate bulletin.

Please note: Self-insured plan sponsors have the option to opt out of waiving copayments, pre-authorization requirements and prescription benefit changes.

2. Will BlueCross/BlueChoice waive pre-authorization requirements for doctor visits and/or treatment? If so, for how long?
BlueCross/BlueChoice will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance for members if diagnosed with COVID-19. However, we ask that you notify us of any inpatient admissions within 3 business days. We will make dedicated clinical staff available to address inquiries related to medical services, ensuring timeliness of responses related to COVID-19.

Please note: Self-insured plan sponsors have the option to opt out of waiving copayments, pre-authorization requirements and prescription benefit changes.

3. Will BlueCross/BlueChoice allow patients to fill/refill an extended supply on prescription drugs and/or waive “refill too soon” limitations?
BlueCross/BlueChoice will increase access to prescription medications by encouraging members to use their 90-day mail order benefit. We will also ensure formulary flexibility if there are shortages or access issues. Patients will not be liable for additional charges that stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues.

Please note: Self-insured plan sponsors have the option to opt out of waiving copayments, pre-authorization requirements and prescription benefit changes.

4. Will you extend the pre-certification timeline to allow time to reschedule and perform currently approved procedures using the same pre-certification?
Yes, existing authorizations will be extended for 180 days.

5. For services that require it, will you honor all currently approved, pre-certified elective, invasive procedures that will be postponed and rescheduled without requiring an additional, new pre-certification for the same patient/procedure until they are scheduled and performed?
Existing authorizations will be extended for 180 days.

6. Will you relax all authorization requirements, i.e. not require authorizations for now?
We will continue to require authorizations on elective admissions, as per our normal procedures.
We will provide additional time for authorizations to be obtained on any emergency admission (3 business days instead of the normal 24 hours or next business day). It is important that we know when a patient has been admitted to the hospital so that we may provide the additional services to the patient and their families, which may include both care management and discharge planning. We understand your teams are very busy and we are here to help!

7. If ERs experience a staffing shortage due to volume or illness of the ER staff, will you reimburse for physicians, other than those specializing in emergency medicine, to submit claims for ER visits?
Yes, as long as the physician has been credentialed, we will accept claims and process without delay.

8. If a lower acuity bed is available for inpatient discharges (COVID-19 related or not) that require subacute or SNF services, will you expedite approval of admissions to those facilities to allow for rapid turnaround of needed inpatient hospital beds?
Yes.

9. Will you waive the credentialing or other administrative requirements?
No, we are not waiving credentialing requirements. However, we are processing credentialing applications as per our normal processes. Applications submitted with complete information are being expedited through the credentialing process.

10. What business continuity plans are in place to ensure that your operations — from a provider service and billing/payment perspective — are addressed?
BlueCross BlueShield of South Carolina has a business continuity plan that has been enacted to ensure continuous, uninterrupted service.

11. What are your policies and procedures related to member responsibility for COVID-19 related testing and care?
You may review the information regarding COVID-19 we have provided to members on our website at www.BlueChoiceSC.com.

Telehealth

 

12. May I provide telehealth services instead of having patients come into the office?

In response to the recent coronavirus (COVID-19) outbreak, BlueCross BlueShield of South Carolina is expanding reimbursement for all services delivered through telehealth that meet the coverage criteria in CAM 176. The expansion supports the diagnosis and treatment of COVID-19 as well as minimizes unnecessary exposure to individuals needing medical care for other conditions. Reimbursement for the expanded set of services delivered through telehealth will be in place for 30 days starting March 16, 2020, and then be reevaluated for possible extension. Claims submitted for these with evaluation and management services reflected by the code sets 99201-99203 and 99211-99215 require a 95 modifier.

Additionally, we are temporarily allowing the use of skype, face time, etc. as acceptable forms of telehealth while applications to participate and implement HIPAA compliant programs are being are being processed. Any providers who would like to participate in our telehealth program may email BlueCross at virtualcare@bcbssc.com to begin the application process.

In some settings, video capability may not be available and for this reason, during this temporary expansion, services may be performed by telephone. The following CPT codes will be included:

  • 99441: Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
  • 99442: Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
  • 99443: Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion

The 95 modifier is NOT required for the telephone services CPT codes.

The above temporary modifications apply to all licensed and credentialed providers in their scope of practice. While these temporary modifications are in place, there will be a waiver of the portion of the CPT verbiage that relates to visits provided within 7 days. Two telephonic services may occur within 7 days during the temporary modification period.

13. Can I provide telehealth services to my Medicaid patients?
On March 19, 2020, and March 23, 2020, the S.C. Dept. of Health and Human Services (SCDHHS) issued bulletins announcing temporary modifications to its telehealth coverage policies for Healthy Connections. These policy changes will remain in effect for the duration of the current declared public health emergency, unless SCDHHS determines they should sunset at an earlier date. SCDHHS will begin accepting claims for these policy changes beginning April 1, 2020.

You can review these and other SCDHHS bulletins in their entirety here: https://msp.scdhhs.gov/covid19/node

14. Can physical therapists, occupational therapists, and speech therapists file for telephone visits?
Yes, we will accept claims for physical therapy, occupational therapy, and speech therapy, using the following codes:

  • 98966: Telephonic Assessment and Management services provided by a qualified non-physician health care professional to an established patient; 5-10 minutes of medical discussion
  • 98967: Telephonic Assessment and Management services provided by a qualified non-physician health care professional to an established patient; 11-20 minutes of medical discussion
  • 98968: Telephonic Assessment and Management services provided by a qualified non-physician health care professional to an established patient; 21-30 minutes of medical discussion

15. What else is BlueCross/BlueChoice doing to support doctors and hospitals with the treatment of COVID-19?
We have business continuity plans in place that we will activate as needed to make sure we continue to meet the needs of our members and provider community throughout the course of this pandemic. We have executed an expansive work from home program for staff to ensure we continue to provide you all services as per our normal processes.

16. What other information resources are available?
CDC: FAQs for Providers: https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html
CDC: Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19)
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fclinical-criteria.html

COVID-19 Coding

 

17. What CPT modifiers are available to use to identify cases that are related to COVID-19?
Modifier CR has been designated by CMS to identify cases that are related to COVID-19. The CR modifier is for filing CPT codes on HCFA1500’s and should be attached to the appropriate E&M code for the office visit. The DR condition code should be filed on institutional UB92 claims.

18. What CPT codes should be used for COVID-19 testing?
U0001 - 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel; use when specimens are sent to the CDC and CDC-approved local/state health department laboratories.

U0002 - 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC; use when specimens are sent to commercial laboratories, e.g. Quest or LabCorp, and not to the CDC or CDC-approved local/state health department laboratories.

87635 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique. This is a new code, created by the American Medical Association and effective immediately, to help labs efficiently report and track testing services related to SARS-CoV-2 and streamline the reporting and reimbursement for this test in the US.

19. What CPT, HCPCS, IDC-10 and other codes should I be aware of related to COVID-19?
Reporting codes related to COVID-19 include:

ICD-10 Reporting Codes
WHO has created an emergency ICD-10 code: U07.1, 2019-nCoV acute respiratory disease. It will be implemented into ICD-10-CM with the update effective April 1, 2020. Until then, providers must use available ICD-10 codes and guidance.

Exposure to COVID-19
Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out); use for cases where there was a concern about possible exposure to COVID-19, but was ruled out after evaluation.

Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases); use for cases where there is an actual exposure to someone who is confirmed to have COVID-19.

Signs and Symptoms
For patients with any COVID-19 signs or symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms; for example, R05 (Cough); R06.02 (Shortness of breath); R50.9 (Fever, unspecified).

Pneumonia
For a case confirmed as due to COVID-19:
J12.89 (Other viral pneumonia);
B97.29 (Other coronavirus as the cause of diseases classified elsewhere)

Bronchitis
For acute bronchitis confirmed as due to COVID-19:
J20.8 (Acute bronchitis);
B97.29 (Other coronavirus as the cause of diseases classified elsewhere)

For bronchitis not otherwise specified (NOS) due to the COVID-19:
J40 (Bronchitis, not specified as acute or chronic);
B97.29 (Other coronavirus as the cause of diseases classified elsewhere)

Lower Respiratory Infection
If COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS:
J22 (Unspecified acute lower respiratory infection);
B97.29 (Other coronavirus as the cause of diseases classified elsewhere)

If COVID-19 is documented as being associated with a respiratory infection, NOS:
J98.8 (Other specified respiratory disorders);
B97.29 (Other coronavirus as the cause of diseases classified elsewhere)

ARDS
For ARDS due to COVID-19:
J80 (Acute respiratory distress syndrome);
B97.29 (Other coronavirus as the cause of diseases classified elsewhere)

Other Coding Notes
Do not use diagnosis code B34.2 (Coronavirus infection, unspecified) for COVID-19, because cases have universally been respiratory in nature, so the site would not be “unspecified.”

If you document “suspected,” “possible” or “probable” COVID-19, do not assign code B97.29. Assign a code(s) explaining the reason for encounter (for example fever, or Z20.828).

Updates as of April 14, 2020

20. What place of service should be used for telehealth services?
There is no place of service restriction on telehealth services.

21. What is the turnaround time for the telehealth/telemedicine application?
We have been able to respond within 24-48 hours.

22. Are your systems across all lines of business ready to accept claims for routinely billed Allied Health Professional services (i.e. PT, OT, ST, Diabetes Management, Nutrition Therapy, etc.) rendered in inpatient and outpatient settings, using the 95 modifier?
Yes, for PT, OT and ST. See the bulletin by clicking here. The other services are currently under review.

NOTE: The requirement for HIPAA compliant platforms has been lifted during this pandemic.

23. Does telehealth apply to all lines of business with BlueCross to include State and BlueChoice?
Yes, this applies to all commercial lines of business as well as Medicare Advantage and FEP.

24. What place of service should be used for telephonic services?
There is no place of service restriction on telephonic services.

25. What labs can do COVID-19 testing?

  • Quest
  • BioReference
  • LabCorp
  • AIT (American Institute of Tox)
  • CPL (Clinical Pathology Lab)
  • Eurofins-Diatherix
  • Eurofins-NTD
  • Eurofins-EGL
  • MDL (Medical Diagnostic Lab)

26. Will your health plan adopt CMS guidelines for all of your applicable plans such as Commercial, Medicare Advantage and Managed Medicaid?
All COVID-19 exceptions are being sent via bulletin and can be found here. Medicare Advantage will abide by CMS directives pertaining to Medicare benefits and coverage criteria.

27. Are there any additional expansions?
We will be including the following in the temporary expansion of the telehealth policy: Observation care, Inpatient hospital care (99217-99226, 99231-99236, 99238-99239), emergency department care (99281-99285), and Critical Care (99291-99292).

28. Will the telehealth expansion be extended?
Effective April 9, 2020, the expansion of telehealth services has been extended to May 16, 2020 with reevaluation for possible extension on or after May 16, 2020.

29. How will home health services be handled during the COVID-19 pandemic?
In response to the recent coronavirus (COVID-19) outbreak, Blue Cross Blue Shield of South Carolina is waiving the homebound requirement for services addressed in CAM 222. The expansion supports the diagnosis and treatment of COVID-19 as well as minimizes unnecessary exposure to individuals needing medical care for other conditions. This expansion will be reviewed for extension on May 16, 2020.
 
NOTE: After clicking the CAM 222 link, accept the disclaimer and search for “Home Health”.

Updates as of April 27, 2020

30. How will out of network (OON) claims related to COVID-19 be processed?
Out of network claims will be processed at 100% of the allowed amount, as long as the COVID-19 criterion is met.

31. Are we able to use non-HIPAA compliant platforms for telehealth services?
Yes, during the COVID-19 pandemic, non-HIPAA compliant platforms are being allowed.  However, once the pandemic is over, you will be required to utilize an approved, HIPAA compliant platform.

32. Are providers required to enroll in telehealth/telemedicine during the COVID-19 pandemic?
Telehealth is covered for in-network provider specialties and services as listed in CAM 176.  Providers are required to enroll in the telehealth program prior to rendering services.  To enroll, providers will need to do the following:

  • Complete the Virtual Care Services Application.
  • Email the completed application to VirtualCare@bcbssc.com.
  • Your office will be notified once the location and physicians have been approved.

33. Are providers required to enroll in telehealth/telemedicine to perform telephonic services during the COVID-19 pandemic?
Telephonic services are covered for in-network provider specialties and services as listed in CAM 176.  Providers are not required to enroll in the telehealth program to perform these telephonic services:

  • 99441: Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion 
  • 99442: Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion 
  • 99443: Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of  medical discussion
  • 98966 (non-physician): Telephone assessment and management service provided by  qualified non-physician healthcare professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days, nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment;  5-10 minutes of medical discussion 
  • 98967 (non-physician): Telephone assessment and management service provided by  qualified non-physician healthcare professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days, nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment;  11-20 minutes of medical discussion
  • 98968 (non-physician): Telephone assessment and management service provided by  qualified non-physician healthcare professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days, nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment;  21-30 minutes of medical discussion

34. How will services be covered at 100% of the allowed amount for COVID-19 testing and treatment?
In order for testing and treatment related to COVID-19 to be covered at 100% of the allowed amount, the claim must be submitted with the appropriate diagnoses and meets the criteria for medical necessity.

If a patient is sick and in the hospital, but does not have COVID-19 (even if they have similar symptoms), their claims will not be processed at 100% of the allowed amount.  Their contracted benefits will apply.

35. What modifiers are appropriate for physical, occupational and speech therapy when rendering telehealth services?
The 95 modifier is the primary modifier that needs to be included on PT, OT and ST claims.  However, the GT, GQ, GN and GO modifiers can also be included.

36. Will pediatric preventive services be included in telehealth coverage for COVID-19?
Effective 04/16/2020, telehealth services have been expanded to allow for preventive medicine services for pediatric patients between the ages of 2-21. These services will be represented by the code sets 99382-99385 and 99392-99395 and must be filed with the 95 modifier.

37. Will out of network providers be included in the temporary telehealth expansion?
No.  The temporary telehealth expansion ONLY applies to in network, South Carolina providers.

38. When should we use the place of service (POS) code 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.

39. Is BlueCross BlueShield of South Carolina covering the cost of testing and treatment for COVID-19 related services for members with a Medicare Advantage High Deductible Health Plan (HDHP)?
Medically necessary services related to COVID-19 will not apply to the deductible for Medicare Advantage members with an HDHP. Services that are consistent with CDC guidance related to COVID-19 and covered at 100% include diagnostic tests and related services such as office visits, urgent care and ER visits.

40. Will telehealth services be expanded for home health care and hospice?
Yes, as of 04/16/2020, a temporary expansion of home health services and hospice services  allows these services to be provided via telehealth when filed with a 95 modifier, subject to the member’s benefits and limitations during the COVID-19 pandemic:  99341-99350, G0151-G0155, G0159-G0162, S9127-S9131, G0299, G0300,Q5001, S9123, S9124, T1030, T1031, 92507, 92521-92526, 97110, 97112, 97129, 97130, 97161-97168 and 97530.

Updates as of May 6, 2020

41. Will BlueCross and BlueChoice provide coverage for necessary/required pre-operative COVID-19 testing once facilities re-open for elective surgeries?  If so, will the same rules (i.e. cost-sharing, prior authorization, etc.) apply this purpose?

Yes, as long as services are rendered during the “emergency period”, COVID-19 testing will be covered at no cost share to the member and the same rules will apply.

42. Will BlueCross and BlueChoice cover genetic counseling under the temporary telehealth expansion?

Yes, CPT codes 96040 and S0265 are included in coverage.  Refer to CAM 176 for the latest telehealth guidelines.

43. Are any additional CPT codes included in coverage for speech therapy services rendered via telehealth?

Yes, CPT code 92610 has been included in coverage.  Refer to CAM 176 for the latest telehealth guidelines.

Updates as of May 11, 2020

44. Will there be another extension to the telehealth expansion?
Yes, the expansion of telehealth services has been extended to June 15, 2020 with reevaluation for possible extension on or after June 15, 2020.

45. Will authorizations for DME also be extended?
Yes, approved authorizations were extended for 180 days.

Updates as of May 22, 2020

46. Is a separate Telehealth application required for each location?

No, only one application is required. However, be sure to include the Tax IDs, all NPIs and all locations that need to be enrolled. You may attach a spreadsheet to the application if you have several locations.