Provider Central

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

We’d like to communicate these three things:

• A new temporary COVID-19 payment policy
• New COVID-19 lab testing codes
• Reminders about telehealth claim submissions

Temporary COVID-19 payment policy effective immediately

We have developed a temporary COVID-19 payment policy to remain in effect during the Massachusetts public health state of emergency.

This new temporary policy includes a collection of policy updates that outlines how Blue Cross reimburses for COVID-19 related services, with guidance from the Centers for Disease Control, the Centers for Medicare & Medicaid Services, state health departments, the American Medical Association, and other relevant health organizations.

What’s included in this new policy?

• Consolidated information that we previously published
• New information about:

• • Ambulance services
  • Autism services
  • Field hospital billing
  • Informational modifiers for reporting
  • New HCPCS codes for COVID-19 testing
  • Place of service billing
  • Specimen collection coding
  • Temporary documentation requirements for telehealth or telephone E/M visits

New COVID-19 lab testing codes

The Centers for Medicare & Medicaid Services created two new HCPCS codes for COVID-19 lab testing. These codes are included in the COVID-19 payment policy and will be added to the applicable provider fee schedules for all products. 

Fee schedules will be updated
We will update our professional, hospital outpatient, and clinical laboratory fee schedules accordingly.

Reminders about telehealth claim submissions

We’ve received calls from members who have been charged a cost share (copayments, co-insurance, and deductibles) for their telehealth or telephonic visit because the services were not billed with a modifier. Since we removed member cost share for all telehealth services (both COVID-19 and non-COVID-19-related) for in-network providers, the member should not be charged anything for telehealth or telephonic visits.

These services include:

• A telephone call in place of an office visit
• A virtual visit/video service

Exception: For FEP, applicable cost share applies for all non-COVID-19 services provided by a non-Teladoc provider.

Use modifiers and place of service when applicable
Please review our COVID-19 payment policy to make sure you are including the correct modifiers and place of service on your claims, when applicable.

• Modifiers (GT, 95, GO, GQ) are required on all video/telehealth claims. Please follow industry-standard practice of including the modifier on all lines of the claim form.
• Depending on your provider specialty, modifiers may or may not be required on claims for telephonic/telehealth visits. Please see our payment policy for details.
• Include the place of service.

Replacement claims
If you’ve submitted claims for telehealth or telephonic visits with dates of service between March 16, 2020 and today, and there’s a patient liability (cost share) that you think may have been applied incorrectly due to the way you billed, do not submit a new claim. Instead:

• Submit a replacement claim with changes for reprocessing.
• Use frequency code 7 and update the claim.

See our replacement claims page for more information.

Resources

• COVID-19 payment policy
• Laboratory and Pathology Payment Policy
• Replacement claims information
• COVID-19 Information page

Questions?

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

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