As you know, BCBSRI’s temporary payment policy for telemedicine/telephone services is in effect until the end of this year. We made changes to our telemedicine/telephone services policy in March of this year to expand coverage and waive members’ cost share for telemedicine services, to help them get the care they needed from home during the COVID-19 pandemic. Under this policy, we also reimbursed telemedicine services at 100% of the in-office allowable amount.

Our temporary payment policy and the cost share waiver will expire on 31 de diciembre, and starting 1 de enero de 2021, it will be updated to continue to offer members an expanded list of covered services by video or phone. These will include clinically appropriate telemedicine visits with their primary care provider, specialists, and behavioral health providers. However, members will pay a cost share for telemedicine services starting with dates of service of 1 de enero de 2021 or later. Any member cost share for these services will follow standard benefits as outlined in their benefit booklet or subscriber agreement.

BCBSRI will continue to reimburse telemedicine or telephone-only services or encounters at 100% of the in-office allowable amount for any clinically appropriate, medically necessary covered health service, for commercial and Medicare Advantage plans. See specific information and guidelines for each group below:

Commercial:

• The Telemedicine/Telephone Services for Commercial Products policy outlines the provider specialties and services (by code) that can be performed via telemedicine as well as telephone only.
• Codes 99211 and 99212 will continue be covered with no member cost share, for primary care and behavioral health providers. This includes advanced practitioners rendering primary care and behavioral health services.
• All other codes and services will apply the appropriate cost share under the member’s benefit plan.

Medicare Advantage:

• BCBSRI will implement the CMS listing of codes and services that are allowed via telemedicine/telephone only. We will align our updated policy as closely as possible with CMS claims filing rules. Please see the updated policy here for more details.
• All codes and services will apply the appropriate cost share under the member’s benefit plan.
• There are new enhanced benefits with no cost share for primary care and behavioral health providers for 2021.
• Please refer to the Telemedicine/Telephone Services for BlueCHiP for Medicare Products during the Public Health Emergency (PHE) policy for additional information.

Claims processing guidelines for all products

Please follow these guidelines to ensure correct claims processing:

• Claims for services provided via a Real-Time Interactive Audio and Video Telecommunications System must be filed with POS 02 and the 95 modifier appended to the claim.
• Claims for telephone-only services must be filed with POS 02. No modifier is needed for telephone-only services – just file the appropriate code for the service you rendered.
• As the updated policies are effective for dates of service 1 de enero de 2021 and after, providers will no longer need to append the CR modifier to ANY of their telemedicine claims.

See full details of the policies here, and if you have any questions, please contact your Provider Relations Representative or ProviderRelations@bcbsri.org. Be on the lookout for an email invitation to our informational webinars, where we’ll review these updated policies.

Thank you as always for your support and partnership as a BCBSRI network provider. We’re thankful for the services you’re providing to our members during the pandemic. Happy holidays from all of us at BCBSRI!