Telehealth – Future State
In response to the COVID-19 pandemic, Blue Cross and Blue Shield of Texas (BCBSTX) expanded access to telehealth services to give our members greater access to care. Moving into 2021 as the COVID-19 accommodations expire, telehealth will continue to be a standard offering for our members. Members will be able to access their medically necessary, covered benefits through network providers who deliver services through telehealth.
Cost-share waiver ending
We waived all cost share associated with telehealth visits during the COVID-19 crisis. The cost-share waiver will end on Dec. 31, 2020. Starting Jan. 1, 2021, copays, deductibles and coinsurance will be applicable to telehealth visits.
The cost share varies according to the member’s benefit plans. Some 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.
The cost share waiver for Medicare Advantage and Medicare Supplement members will end on Dec. 31, 2020. Starting Jan. 1, 2021, copays, deductibles and coinsurance will apply to telehealth visits.
What is covered?
Coverage is based on the terms of the member’s benefit plan and applicable law. Starting Jan. 1, 2021, we will cover telehealth codes consistent with the code lists from:
This does not include CMS’ list of telehealth services for the public health emergency.
Our self-funded employer group customers make decisions for their employee benefit plans. Check eligibility and benefits for any variations in member benefit plans.
CMS identifies covered services for Medicare members.
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 telehealth when it enhances the continuity of care and care integration if you have an established patient-provider relationship with members.
- Integrate telehealth records into electronic medical record systems to enhance continuity of care, maintain robust clinical documentation and improve patient outcomes.
Providers can use telehealth for members with the following types of benefit plans.
- State-regulated fully insured HMO and PPO plans
- Blue Cross Medicare Advantage (excluding Part D) and Medicare Supplement
- Self-funded employer group plans
We will continue to follow applicable state and federal requirements.
Medicare and Medicaid
Telehealth benefits for our Medicare Advantage and Medicare Supplement members will continue until CMS directs .
We will follow the applicable guidelines of the Texas Department of State and Health Services and CMS as appropriate for Medicare Advantage, Medicare Supplement, Medicaid STAR, CHIP and STAR Kids members.
Available telehealth visits with BCBSTX providers include:
- 2-way, live interactive telephone communication 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, which can allow members to connect with physicians while reducing the risk of exposure to contagious viruses or further illness
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 .
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.
The provider submitting the claim is responsible for accurately coding the service performed. Submit claims for medically necessary services delivered via telehealth with the appropriate modifiers (95, GT, GQ) and Place of Service (POS) 02 or POS that would have been billed had the services been delivered face to face.
Note: If a claim is submitted using a telehealth code, the modifier 95 is not necessary. Only codes that are not traditional telehealth codes require the modifier.
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. Submit claims with appropriate codes and modifiers. For claims using a specific telehealth code, the applicable 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:
- Verify general coverage by submitting an electronic 270 transaction through Availity® or your preferred vendor.
- Connect with a Customer Advocate to check eligibility and telehealth benefits by calling our Provider Customer Service Center at 1-800-451-0287.
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association