We have extended our waiver for prior authorizations. Starting with dates of service on or after October 1, 2020, you will need to submit authorizations. Learn more.
We have added information previously found on the Federal Employee Program (FEP) website about member cost share FEP members.
Update issued: Apr 14, 2020This article is for all Blue Cross Blue Shield of Massachusetts providers (except dental)
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We are closely monitoring the coronavirus (COVID-19). Because this situation is fluid and fast-moving, we will publish the latest information on our COVID-19 Information page for our health care partners. Please check this page often for the latest updates.
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 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.
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 |
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.
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.
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.
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.
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:
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:
Telehealth (Telemedicine) Medical payment policy
Telehealth (Telemedicine) Behavioral Health payment policy
Telehealth (Telemedicine) Medical payment policy
Telehealth (Telemedicine) Behavioral Health payment policy
Important note: This information only applies to the ancillary and behavioral health specialties on this list.
Referrals and prior authorizations are not required for medically appropriate care for COVID-19.
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.
For COVID-19-related benefit changes impacting the Federal Employee Program, please see fepblue.org/coronavirus.
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.
Call Network Management and Credentialing Services at 1-800-316-BLUE (2583).
Telehealth information
Coronavirus resource center
Laboratory and Pathology payment policy
Telehealth (Telemedicine) Medical payment policy
Telehealth (Telemedicine) Behavioral Health payment policy
Telehealth information
Coronavirus resource center
Laboratory and Pathology payment policy ()
Telehealth (Telemedicine) Medical payment policy ()
Telehealth (Telemedicine) Behavioral Health payment policy ()
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