**Bold items updated on 5/10**

As you are likely aware, the Federal Public Health Emergency (PHE) is ending May 11, 2023, and the Rhode Island State of Emergency (SOE) is ending May 5, 2023. With the PHE and SOE ending, COVID related BCBSRI Payment Policies will be updated and posted to bcbsri.com. Noted below is a high-level summary of updates along with the applicable effective dates. Please refer to the published Payment Policies for specific details:

Commercial:

• Telemedicine/Telephone Services for Commercial Products:
  • CPT Codes 99211 & 99212 will revert to applying member cost share for primary care including advanced practitioners and behavioral health psychiatrists and clinical nurse specialists for dates of services on or after May 12, 2023.
  • Telemedicine services will continue to be reimbursed at 100% of the in-office allowable amount/reimbursement rate.
• TEMPORARY Cost Share Waiver for Treatment of Confirmed Cases of COVID-19 During the COVID-19 Crisis: Will revert to the pre-COVID plan design and apply the members appropriate benefit cost share for the service(s) provided effective May 12, 2023.
• TEMPORARY Encounter for Determination of Need for COVID-19 Diagnostic Testing: Will also revert to pre-COVID plan design and apply the members appropriate benefit cost share effective May 12, 2023.
• TEMPORARY COVID-19 Diagnostic Testing: Over the Counter (OTC) home test (without provider order) will no longer be covered regardless of the purchasing location effective May 12, 2023.
  • This change applies to BCBSRI fully insured and municipal self-funded employer accounts/coverage. OTC home tests with a provider order will continue to be covered at 100%.
• COVID-19 Pediatric Vaccination Preventative Medicine Counseling: Effective July 10, 2023, CPT Code 99401CR for Vaccination Preventative Medicine Counseling Services will revert to a not separately reimbursable service.
• COVID Vaccinations: will continue to be covered at 100% of our allowable rate as a preventive service.
• Split Preventative Visits: Effective May 12, 2023, BCBSRI will no longer allow for split preventative visits. Offices will no longer be able to perform the screening type questions via audiovisual or telephone only and then bring the patient in for immunizations and a physical exam. These codes consist of 99381-99397.

Medicare Advantage:

• Telemedicine: All indicated codes included in the current Telemedicine/Telephone Services for Medicare Advantage Plans During COVID-19 Public Health Emergency, shall remain at $0 cost share through December 31, 2023.
• TEMPORARY Cost Share Waiver for Treatment of Confirmed Cases of COVID-19 During the COVID-19 Crisis: will revert to the pre-covid plan design and apply member cost share effective July 1, 2023.
• Referrals: Referrals will be required/revert back to pre-COVID requirements for dates of service effective July 1, 2023. Any claims for dates of services on or after July 1, 2023, with no referral or authorization will be denied.
• TEMPORARY COVID-19 Diagnostic Testing: Over the Counter (OTC) home tests kits will continue to be covered until July 1, 2023.
• COVID-19 Vaccinations: will continue to be covered at 100% until December 31, 2023.
• Out of Network Services: Coverage for out of network providers will process at the members out of network benefit levels following all prior benefits rules effective July 1, 2023. 
• Skilled Nursing Facilities (SNF): All Medicare Beneficiaries' SNF benefits will require a 60-day break in services for a new benefit period to apply.
  • This change will be effective for SNF admission as of May 12, 2023.

• COVID Testing (Commercial and Medicare): CPT Codes U0003, U0004 and U0005 will no longer be covered and reimbursed for services on or after May 12, 2023.

• Laboratory Testing (Commercial and Medicare): CPT Codes G2023 and G2024 will no longer be covered and reimbursed for services on or after May 12, 2023.

Both the Commercial and Medicare Telemedicine Policies will be updated related to the PHE ending:

• Telemedicine/Telephone Services for Commercial Products - Effective 8/3/2022
• Telemedicine/Telephone Services for Medicare Advantage Plans during the Public Health Emergency (PHE) - Effective 8/3/2022

The following Temporary COVID policies with updates will remain on the Medical and Payment Policies page of bcbsri.com for one year:

• TEMPORARY COVID-19 Pediatric Vaccination Preventative Medicine Counseling Services for Commercial Members
• TEMPORARY Cost Share Waiver for Treatment of Confirmed Cases of COVID-19
• TEMPORARY COVID-19 Diagnostic Testing
• TEMPORARY COVID-19 Pediatric Vaccination Preventative Medicine Counseling Services for Commercial Members
• TEMPORARY Encounter for Determination of Need for COVID-19 Diagnostic Testing Effective 3/18/20

The following Policies will be updated related to the PHE ending:

• COVID-19 Diagnostic Testing, Vaccine and Antibody Treatment Administration Reimbursement
• COVID-19 Monoclonal Antibody Treatment and Antiviral IV Medications
• COVID-19 Vaccinations

Please note BCBSRI is working on updating our email blast system. There will be no email blasts sent between May 3rd – June 15th. Any future updates and email updates including the monthly Provider Conference Call invite will be posted to our Alerts and Updates Section and the Provider Relations section of the monthly Provider Update.