Provider Central

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.

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:

COVID-19 diagnosis

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

*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.

For medically necessary inpatient acute care hospital services, we are waiving member cost share when the claim includes a diagnosis of COVID-19. Read our April 7 news article.

For Federal Employee Program (FEP) members:

Member cost share will also be removed for inpatient acute care hospitals, inpatient rehab facilities, long term acute care hospitals, and skilled nursing facilities for services related to COVID-19.

We’ve removed the member cost share for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. Members can register for Teladoc by visiting fepblue.org/coronavirus. For other providers offering telehealth services, the applicable cost share will apply (unless COVID-19 related).

FEP will determine coverage for the vaccine once it becomes available.

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.
• If you are submitting 1500 claims using Direct Data Entry in Online Services, please do not use separate fields for each character of the modifier. The screenshot below shows the correct way to enter modifiers.
  
  
  

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.

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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