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March 12, 2020
Dear Customers,
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We have been given the following information from our BCBS Provider Network Consultant today:
- The MD allowable for all CPT codes listed below is $44.00 (the rate will be lower for non- MD’s **we do not know this amount at this time)
- The Telehealth Place of Service Code is 02- use this instead of 11 (office)
- You bill one of these 6 codes-not your normal CPT code
- 99441-99443 are for speaking to the patient via the Telephone
- 99421-99423 are for using Skype, Facetime or other tool with the patient -this is an acceptable method at this time based on the current COVID-19 situation
- Patient’s copays and deductibles are waived at this time for these 6 CPT codes-BCBS will pay the allowed amount
- Preauthorization will be waived for these codes at this time if the patient’s policy requires one
- Do not call BCBS at this time to check benefits- their phones are flooded with calls
- Use Availity, Eligibility & Benefits to check the policy that there is coverage for these codes. Not all policies cover Telehealth services.
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Blue Cross and Blue Shield of Illinois Expands Telehealth Program Effective March 10, 2020
Blue Cross and Blue Shield of Illinois (BCBSIL) recognizes that BCBSIL members and providers may desire flexible options for access to care while our health care system is meeting the demands created by the coronavirus disease 2019 (COVID-19). To help meet those needs, BCBSIL is accelerating the implementation of our Telehealth program.
Effective March 10, 2020, BCBSIL began accepting the following Telehealth codes for eligible BCBSIL PPO and Blue Choice members. BCBSIL will follow the applicable guidelines of the Illinois Department of Human Services and Centers for Medicare & Medicaid Services as appropriate for Blue Cross Community Health PlansSM (BCCHPSM) (Medicaid Plans), Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Medicare Advantage (PPO)SM Plans.
Code
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Description
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99441
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Physician /Qualified Health Professional telephone evaluation 5-10 min
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99442
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Physician /Qualified Health Professional telephone evaluation 11-20 min
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99443
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Physician/Qualified Health Professional telephone evaluation 21-30 min
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99421
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Physician/Qualified Health Professional online digital evaluation 5-10 min
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99422
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Physician/Qualified Health Professional online digital evaluation 11-20 min
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99423
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Physician/Qualified Health Professional online digital evaluation 21-30 min
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Covered telehealth visits currently include 2-way, live interactive telephone communication and digital video consultations, which can allow concerned members to connect with their physicians while reducing the risk of exposure to contagious viruses or further illness. |
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This telehealth expansion is in addition to BCBSIL’s other actions to facilitate increasing access to care for our members related to COVID-19:
- BCBSIL will not require preauthorization and will not apply co-pays or deductibles for testing to diagnose COVID-19 when medically necessary and consistent with Centers for Disease Control and Prevention (CDC) guidance.
This applies to all members insured by BCBSIL. Many of our members are covered under a health plan that is self-insured by their employer. BCBSIL will continue to share relevant information to employers considering health plan issues related to COVID-19.
- With regard to treatment for COVID-19, BCBSIL covers medically necessary health care services, including, but not limited to, physician services, hospitalization, and emergency services, consistent with the terms of our members’ BCBSIL benefit plans.
As a reminder, it is critical to check eligibility and benefits for each member at every visit prior to rendering services. You may check eligibility and benefits by submitting an electronic 270 transaction via the Availity® Provider Portal or your preferred vendor portal. This step will help you determine coverage information, network status, benefit preauthorization/pre-notification requirements and other important details.
Continue to watch the News and Updates section of the BCBSIL provider website for more information. If you have further questions, please contact your Provider Network Consultant. For the most up to date information about COVID-19, visit the Centers for Disease Control and Prevention website. |
Checking eligibility and benefits and/or obtaining preauthorization/pre-notification is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any preauthorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. |
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