Temporary Expansion of Reimbursement for Telehealth Services

Temporary Expansion of Reimbursement for Telehealth Services

In response to the recent coronavirus (COVID-19) outbreak, BlueCross BlueShield of South Carolina and its subsidiary BlueChoice® HealthPlan are expanding reimbursement for all services delivered through telehealth that meet the coverage criteria in the medical policy (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 thirty (30) days starting March 16, 2020 and then be reevaluated for possible extension. Effective immediately (March 19, 2020), claims submitted with evaluation and management services reflected by the code sets 99201-99203 and 99211-99215 require a 95 modifier.

NOTE: 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.

 

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 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 

Submission of the 95 modifier IS NOT required for codes 99441-99443, as these codes specifically describe the service provided.

 

After clicking the link to CAM 176, accept the disclaimer and then search for "Telehealth".

Note: Medical record documentation may be requested and audited to confirm the medical appropriateness of these telephone-based services.

Providers who wish to provide telehealth care in a synchronous manner using simultaneous audio-visual with HIPAA-compliant technology will need to complete the Virtual Care Services Form and email it to BlueCross at virtualcare@bcbssc.com to express interest.

For any additional questions, please contact Provider Education using the Provider Education Contact Form located on www.BlueChoiceSC.com.

See the FAQs for COVID-19 here.