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COVID-19: Latest news (March 24)
March 24, 2020

This article is for all Blue Cross Blue Shield of Massachusetts providers (except dental)

We are closely monitoring the coronavirus (COVID-19). Because this situation is fluid and fast-moving, we will publish updates to this article. Members can also find information on our Coronavirus Resource Center.

Blue Cross Blue Shield of Massachusetts values our partnership with you, and we will do everything we can to support you as you care for your patients—our members—during this time. We are following the Centers for Disease Control’s (CDC) Prevention guidelines along with Governor Baker’s emergency order and federal mandates and will continue to support and protect the health and well-being of members and the community.

New codes for providers and laboratories

New codes were recently announced for providers and laboratories to test patients for COVID-19. These codes will apply to all commercial, Federal Employee Program (FEP), and Medicare Advantage members. For FEP coverage guidelines, see information below.

Code Service description Reimbursement effective date
U0001
(HCPCS)
CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel Effective April 1, 2020 for dates of service on or after February 4, 2020
U0002
(HCPCS)
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC
87635
(CPT)
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique Effective March 13, 2020

We have updated our Laboratory and Pathology payment policy to reflect these codes.

We will update ancillary and behavioral health fee schedules accordingly. 

We have updated our Laboratory and Pathology payment policy to reflect these codes.

We will update ancillary and behavioral health fee schedules accordingly. To see your fee schedule, log in and go to Office Resources>Billing & Reimbursement>Fee Schedules.

Diagnosis codes

Symptomatic/No diagnosis yet

Use the diagnosis codes below for patients presenting for evaluation of suspected COVID-19.

In accordance with CDC and Department of Public Health DPH guidelines, we expect providers to code for COVID-19 testing and treatment, including supportive services for symptoms related to COVID-19 at doctor’s offices, emergency rooms, and urgent care centers. Blue Cross will identify patients presenting for evaluation of possible COVID-19 using the below codes:

Diagnosis code* Service description
Z20.828 Contact with and (suspected) exposure to other viral communicable diseases
Z03.818 Encounter for observation for suspected exposure to other biological agents ruled out
Z11.59 Encounter for screening for other viral diseases

COVID-19 diagnosis

If your patient has a previously confirmed COVID-19 illness or tests positive for COVID-19, use the codes below.

Diagnosis code* Service description

B97.29

Other coronavirus as the cause of diseases classified elsewhere
B97.21 SARS-associated coronavirus as the cause of diseases classified elsewhere
U07.1 2019-nCOV acute respiratory disease (effective April 1, 2020)
B34.2 Coronavirus infection, unspecified

*The CDC has created an interim set of ICD-10 CM official coding guidelines, effective February 20, 2020.

Waiving member cost share

We are removing all member cost share (copayments, co-insurance, and deductibles) for a telephone (telephonic) call in place of an office visit, and a virtual/video appointment (telehealth) services for all COVID-19 and non-COVID-19-related services for in-network providers. This is in place for the duration of the Massachusetts state of emergency.

For in-person doctor, urgent care and emergency room visits related to the testing, counseling, vaccination, and treatment of COVID-19, we are removing all member cost share. This is in place for the duration of the Massachusetts state of emergency.

Member cost share will still apply to inpatient services.

Coverage and site of service expansion

Effective for dates of service retroactive to March 16, 2020, all in-network providers may deliver all medically necessary covered services (COVID-19 AND non-COVID-19 related) via any modality. This includes telehealth (video), telephonic (audio) or in-person to all Blue Cross Blue Shield of Massachusetts members. We will reimburse at the same rate as an in-person visit for all provider specialties, including ancillary. This is in place for the duration of the Massachusetts state of emergency.

You can offer telehealth services as long as you are contracted and credentialed by Blue Cross Blue Shield of Massachusetts. There are no additional credentialing or contracting processes you need to follow to offer telehealth services.

The U.S. Department of Health and Human Services and the Office of Civil Rights have relaxed HIPAA requirements related to the use of telehealth services during the COVID-19 nationwide public health emergency. See the Notification of Enforcement Discretion for telehealth.

Telehealth and telephonic services

Starting immediately, Blue Cross will cover visits through telehealth or by telephone (“telephonic visits”). Follow the telehealth billing guidelines to bill for telehealth services the same as you would as in-person and include the following modifiers with place of service 02:

  • Practitioners must use modifier GT, 95, G0, or GQ (via synchronous/asynchronous telehealth audio and/or video telecommunications systems to differentiate a telehealth (telemedicine) encounter from an in-person encounter with the patient.
  • When reporting modifier GT, 95, G0, or GQ the practitioner is attesting that services were rendered to a patient via synchronous/asynchronous telehealth audio and/or video telecommunications systems.

Bill for telephonic services using the telephonic CPT codes as indicated in the telehealth billing guidelines with place of service 02.

The billing guidelines are included in the following payment policies:

For ancillary and a subset of behavioral health providers

Important note: This information only applies to the ancillary and behavioral health specialties on this list.

  • When you provide any telephonic services, do not bill the specific telephonic CPT codes. Bill all covered services that you render either by telehealth/video or telephone as if you are performing a face-to-face service using the codes that are currently on your fee schedule.
  • You must use one of the following telehealth modifiers listed above (GT, 95, G0, and GQ) and place of service 02. This will enable us to pay you the same rate we pay you for in-person, face-to-face visits.

Referrals and authorizations

Referrals and prior authorizations are not required for medically appropriate care for COVID-19.

During the COVID-19 declared Massachusetts state of emergency and to facilitate inpatient capacity across the health delivery system, Blue Cross Blue Shield of Massachusetts has moved to a notification-only requirement for all inpatient levels of care (including acute, long-term acute (LTAC), acute and subacute rehabilitation (rehab) and Skilled Nursing Facility (SNF) admissions). As such, medical necessity reviews will not be performed for inpatient levels of care at this time and through June 23, 2020. Timely notification by facilities will help us facilitate optimal care coordination, mobilize additional services to support transition-of-care and discharge planning, and ensure claims processing.

Allowing early prescription refills

We are lifting limits on early refills of prescription medications, allowing members to obtain one additional fill of their existing prescription. This is in place for the duration of the state of emergency.

Federal Employee Program (FEP)

For COVID-19-related benefit changes impacting the Federal Employee Program, please see fepblue.org/coronavirus.

Member coronavirus help line

If your patients have coronavirus benefit questions or would like to speak to a nurse, they can call our dedicated coronavirus help line at 1-888-372-1970.

Questions?

Call Network Management and Credentialing Services at 1-800-316-BLUE (2583).

Resources

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