COVID-19 Coverage Updates for Medicare Providers
As the COVID-19 crisis continues to evolve, Blue Cross and Blue Shield of Texas (BCBSTX) is making changes to serve our Medicare members. We are following Centers for Medicare & Medicaid Services (CMS) guidelines as appropriate. You can find updates in our COVID-19 FAQs for Medicare Providers , including on testing, treatment, telehealth and claims.
Unless otherwise noted, the FAQs refer to our members in these individual and group Medicare Advantage and Medicare Supplement plans:
- Blue Cross Group Medicare Advantage (PPO)SM
- Blue Cross Group Medicare Advantage Open Access (PPO)SM
- Blue Cross Medicare Advantage (HMO)SM
- Blue Cross Medicare Advantage (PPO)SM
- Blue Cross Medicare Advantage Dual Care (HMO SNP)SM
- Blue Cross Medicare SupplementSM
The FAQs include details on:
Coverage for testing, testing-related visits and treatment
Medicare Advantage and Medicare Supplement members won't pay copays, deductibles or coinsurance for:
- Medically necessary lab tests to diagnose COVID-19 that are consistent with CDC guidance
- Testing-related visits related to COVID-19 with in-network* providers, including at a provider's office, urgent care clinic, emergency room and by telehealth
- Treatment for COVID-19 with providers or at facilities from April 1 through Aug. 31, 2020, (previously June 30, 2020). This change may be extended if needed. Members should confirm whether their benefit plan covers services received from out-of-network providers. For questions about benefits, members may call the number on their ID card.
Expanded access to telehealth at no cost-share
Medicare Advantage and Medicare Supplement members can access in-network telehealth services at no cost-share for medically necessary, covered services and treatments consistent with the terms of the member’s benefit plan. Medicare Advantage PPO members have access to telehealth services with out-of-network providers but will be responsible for member cost-share for these services consistent with the terms of their plans. This cost-share waiver for telehealth services applies to claims beginning March 1, 2020.
Telehealth for annual health assessments
Initial and subsequent Annual Wellness Visits (G0438 and G0439) may be conducted by telehealth. Submit claims for wellness visits with Modifier 95 and Place of Service (POS) 11. BCBSTX covers one wellness visit every calendar year.
- Note: CMS has not approved Initial Preventive Physical Examinations (IPPE) (G0402) for telehealth. Members are eligible for the IPPE during their first 12 months of enrollment in Medicare.
To confirm Medicare members’ coverage and benefits, you may use the Availity® Provider Portal or your preferred vendor. To verify telehealth coverage, please call Provider Services at 1-877-774-8592 for individual and 1-877-299-1008 for group members.
- CMS Current Emergencies and News Alerts
- CMS Covered Telehealth Services and Telehealth Codes
*Blue Cross Group Medicare Supplement and Blue Cross Medicare Supplement members do not have network restrictions unless otherwise noted in their plan terms.
Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized/pre-notified 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 any questions, call the number on the member’s ID card.
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 BCBSTX. BCBSTX 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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