Members can access their medically necessary, covered benefits through providers who deliver services through telehealth. Many of our members also have access to various telehealth vendors, such as MDLIVE.
What's covered?
Telemedicine/telehealth services will be provided consistent with the terms of the member's benefit plan. For our state regulated BCBSTX fully insured HMO and PPO members and our self-funded employer group members, providers will be able to deliver services from the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) codes lists as well as expanded telemedicine/telehealth services including but not limited to:
- Intensive outpatient program (IOP) services
- Partial hospitalization programs (PHP)
- Physical therapy (PT)
- Occupational therapy (OT)
- Speech therapy (ST)
You can reference the full code list here.
Our self-funded employer group customers make decisions for their employee benefit plans. Check eligibility and benefits for any variations in member benefit plans.
We recommend the following:
- Consider telehealth a mode of care delivery to be used when it can reasonably provide equivalent outcomes as face-to-face visits.
- Choose telemedicine/telehealth when it enhances the continuity of care and care integration if you have an established patient-provider relationship with members.
- Integrate telemedicine/telehealth records into electronic medical record systems to enhance continuity of care, maintain robust clinical documentation and improve patient outcomes.
Eligible members
Providers can use telemedicine/telehealth for members with the following types of benefit plans. Care must be consistent with the terms of the member's benefit plan.
- State-regulated fully insured HMO and PPO plans
- Blue Cross Medicare Advantage (excluding Part D) and Medicare Supplement (see Medicare info below)
- Self-funded employer group plans
We will continue to follow applicable state and federal requirements.
Member cost share
As of Jan. 1, 2021, copays, deductibles and coinsurance may apply to telemedicine/telehealth visits. The cost share varies according to the member's benefit plans. Check eligibility and benefits for each member for details.
Our self-funded employer group customers make decisions for their employee benefit plans and may choose to waive telemedicine/telehealth cost share. Check eligibility and benefits for any variations in member benefit plans.
What's covered for Medicare Advantage and Medicare Supplement members
CMS identifies covered services for Medicare members. This means we will cover all the CMS telemedicine/telehealth codes, including those available only during the PHE for Medicare Advantage and Medicare Supplement members.
For the duration of the PHE, we are waiving cost share for our Medicare Advantage members. This means these members will not owe any copays, deductibles or coinsurance for telemedicine/telehealth visits. The cost share waiver does not apply to Medicare Supplement members.
Medicaid
We will follow the applicable guidelines of the Texas Health and Human Services Commission for Medicaid STAR, CHIP and STAR Kids members.
Referrals and prior authorizations
Some telemedicine/telehealth care will require referrals and prior authorizations in accordance with the member's benefit plan. Check eligibility and benefits for each member for details.
Delivery methods
Available telemedicine/telehealth visits with BCBSTX providers include:
- 2-way, live interactive telephone communication audio and video communications and digital video consultations
- Asynchronous telecommunication via image and video not provided in real-time (a service is recorded as video or captured as an image; the provider evaluates it later)
- Other methods allowed by state and federal laws
Delivery methods for Medicare members
- Providers should use an interactive audio and video telecommunications system that permits real-time interactive communication to conduct telehealth services. CMS permits audio only in limited circumstances. See the CMS website for designated audio-only codes.
Providers can find the latest guidance on acceptable Health Insurance Portability and Accountability Act (HIPAA) compliant remote technologies issued by the U.S. Department of Health and Human Services' Office for Civil Rights in Action.
Telehealth Vendors
For state-regulated fully insured members, providers are not required to use a vendor for telehealth services. For self-funded members, providers may be required to use specific vendors as outlined in the member's benefit plan.
Submitting claims
The provider submitting the claim is responsible for accurately coding the service performed. Refer to CPCP033 Telemedicine and Telehealth Services on the Clinical Payment and Coding Policies page.
Reimbursement
BCBSTX provides general reimbursement information policies, fee schedule request forms and fee schedule information on the General Reimbursement Information section of the provider website.
Currently, covered telemedicine/telehealth claims for eligible members for in-network medically necessary health care services will be reimbursed at the same rate as in-person office visits for the same service. We will continue to evaluate reimbursement. Submit claims with appropriate codes and modifiers. For claims using a specific telemedicine/telehealth code, the applicable telemedicine/telehealth reimbursement will apply.
Member benefit and eligibility assistance
Check eligibility and benefits for each member at every visit prior to rendering services. Providers may:
- Check general coverage by submitting an electronic 270 transaction through Availity® or your preferred vendor.
- For Commercial plans, connect with a Customer Advocate to check eligibility and telemedicine/telehealth benefits by calling our Provider Customer Service Center at 1-800-451-0287.
- For Medicare Advantage plans, call Blue Cross Medicare Advantage Network Management at 1-972-766-7100.
Have questions?
If you need assistance, please contact your Network Management office.