Provider Information on COVID-19 Coverage
Blue Cross and Blue Shield of Texas (BCBSTX) is covering testing to diagnose the 2019 Novel Coronavirus (COVID-19) for most members with no prior authorization needed and no member copays or deductibles when using in-network providers. For treatment of COVID-19, we cover medically necessary health benefits, including physician services, hospitalization and emergency services consistent with the terms of each member's benefit plan. Members should always call the number on their ID card for answers to their specific benefit questions.
Note: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may be responsible for copays or deductibles.
Check Members Eligibility and Benefits
Use the Availity® Provider Portal or your preferred vendor to check eligibility and benefits.
Claims for COVID-19 Testing
If you test a member when it's medically necessary and consistent with CDC guidance, submit the claim to us using the appropriate code:
- HCPCS code U0002 (Non-CDC lab test)
- CPT code 87635 (American Medical Association (AMA) code for SARS-2-CoV-2 lab test)
The Centers for Medicare and Medicaid Services (CMS) has set the price for the COVID-19 diagnostic tests at $51.33 for U0002 and 87635. We will follow CMS pricing and apply the terms of our contracts.
If you are not in our networks, our allowed amount for U0002 is consistent with Medicare pricing.
Telemedicine and Telehealth
Many members have telehealth benefits. For those members, telehealth visits will be covered as a regular office visit for providers who offer the service through 2-way, live interactive telephone or digital video consultations. Some plans also provide access to MDLive or a similar vendor with a network of physicians who provide telehealth services. For more details, refer to the Using Telemedicine and Telehealth in Response to COVID-19 article in News and Updates as well as our Telemedicine and Telehealth Services page.
For members who have BCBSTX pharmacy benefits administered through Prime Therapeutics, BCBSTX will allow members to receive an early fill of their medication for the same quantity as the last prescription filled. We also encourage members to use their 90-day mail order benefit, if applicable. All pharmacy practice safety measures, as well as prescribing and dispensing laws, will remain.
We are also prepared for medication shortages or access issues. Patients will not be liable for additional charges that may stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues.
What is the risk of COVID-19?
According to recent reports from the CDC, the immediate health risk from COVID-19 is low. We are ready to help you serve our members and the community in understanding, preventing and potentially treating people who have been affected by the COVID-19.
We've developed a member-facing flier about COVID-19 that you may share with your patients.
Because this is a rapidly evolving situation, you should continue to use Centers for Disease Control guidance on COVID-19, as the CDC has the most up-to-date information and recommendations. In addition, watch for updates on BCBSTX News and Updates.
If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.
As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if benefit prior authorization is required for a member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSTX’s provider website.
Please note checking eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member's ID card.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by Availity, Aerial or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.