BCBSRI has updated its Payment Policies for Telemedicine/Telephone Services for Commercial and Medicare Advantage products policy for services rendered on or after January 1, 2021. As a result, BCBSRI’s Temporary Telemedicine/Telehealth and Telephone Services During the COVID-19 Crisis – Effective 3/18/20 policy is no longer in effect for dates of service on or after January 1, 2021.

Key updates:

• BCBSRI will continue to reimburse telemedicine or telephone-only services/encounters at 100% of the in-office allowable amount for any clinically appropriate, medically necessary covered health service for commercial and Medicare Advantage services as outlined in our updated policies.

Commercial:

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

Medicare Advantage:

• BCBSRI will implement the CMS listing of codes and services that are allowed via telemedicine/telephone only and align its updated policy as closely as possible with CMS claims filing rules. Please see the updated policy for more details.
• All codes and services will apply the appropriate member cost share under their 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 filing guidelines for all products:

• As a reminder, 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 January 1, 2021 and after, providers will no longer need to append the CR modifier to ANY of their telemedicine claims.

BCBSRI will offer several webinars to review the updated policies. We’ll email invitations soon.

Full details of the policies are available for review here. If you have any questions related to this new policy, please contact your Provider Relations Representative or email ProviderRelations@bcbsri.org.

As always, we appreciate your partnership and participation with BCBSRI, as well as the services you are providing to our members during the pandemic.