Physicians/Specialists
Facilities/Hospitals
Ancillary
Pharmacy
Publication Date: 
2020-03-26

April 9 Update

We updated this sentence: 

Our COVID-19 measures are in effect as of March 6, 2020. They were extended for an additional 30-day period starting on April 5, 2020, and will be re-evaluated for further extension.


March 27 Update

Updated Clinical guidelines chart


March 26 Update

We updated the "Questions" section below, and removed the intake form link:

  • Blue Cross NC is committed to supporting providers during the COVID-19 pandemic. Please bookmark this page and review all the resources we have here to find answers to your questions. We update this page regularly based on questions we receive, so it's very likely we've answered your question, as well. However, if you can't find the answer here, please email us at COVID19questions@bcbsnc.com. We are experiencing a large volume of inquiries but will respond as soon as possible. 

We also updated this section about the Federal Employee Program (FEP):

  • Some commercial members can access MDLIVE or TeleDoc as a virtual care benefit, as noted on their member ID card. Federal Employee Program (FEP) members can only access virtual care through the TeleDoc service. TeleDoc offers both video or audio virtual services. You can view COVID-19 benefits for the Federal Employee Program here.
    • March 26 Update: The FEP has lifted the requirement for using TelaDoc. FEP members may now see their physicians through a virtual visit.

March 17 Update

We updated the following sentence:

  • The AMA released the CPT code 87635 that may be used by providers as another option to bill for testing for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) (Coronavirus disease [COVID-19]).

We also updated the time of the March 20 event to 3 pm. Please click here to register.


We continue to be committed to the safety of the patients and communities that we serve together. We want to support your heroic efforts to address the COVID-19 outbreak. Here is a summary and detailed guidance on the temporary measures we’ve taken.

Our COVID-19 measures are in effect as of March 6, 2020. They were extended for an additional 30-day period starting on April 5, 2020, and will be re-evaluated for further extension.  

When referenced, the following information applies to all Medicare Advantage plans offered or administered by Blue Cross and Blue Shield of North Carolina, including Experience Health.

Expanded Telehealth Measures - Effective March 6, 2020
Visits to providers that previously required an in-person encounter can be performed virtually and will be paid at parity with office visits as long as they are medically necessary, meet criteria in the updated Blue Cross NC Telehealth Corporate Reimbursement Policy, and occur on or after March 6, 2020.

  • These temporary measures include virtual care encounters for patients that can replace in-person interactions across appropriate care settings, including outpatient clinics, hospitals, and the emergency departments.
  • Please do not file telehealth claims with Blue Cross NC until March 21, 2020 and use Telehealth as Place of Service (02).
  • For providers or members who don’t have access to secure video systems, telephone (audio-only) visits can be used for the virtual visit. Please use both Telehealth as Place of Service and CR (catastrophe/disaster-related) modifier for audio-only visits.
  • If you believe an eligible telehealth claim has been improperly denied, please resubmit it after March 21, 2020.
  • Some commercial members can access MDLIVE or TeleDoc as a virtual care benefit, as noted on their member ID card. Federal Employee Program (FEP) members can only access virtual care through the TeleDoc service. TeleDoc offers both video or audio virtual services. You can view COVID-19 benefits for the Federal Employee Program here.
    • March 26 Update: The FEP has lifted the requirement for using TelaDoc. FEP members may now see their physicians through a virtual visit.

Guidance to Providers Regarding Virtual Visits for Blue Cross NC Commercial and Medicare Advantage Members

The following scenarios reflect the updated Blue Cross NC Telehealth Corporate Reimbursement Policy that will be posted on Monday, March 16, 2020. The policy is in effect for dates of service beginning March 6, 2020 and can be accessed here: https://www.bluecrossnc.com/document/telehealth.  

These measures will remain in effect for a 30-day period, starting March 6, 2020, and then be re-evaluated for extension.

Clinical Scenarios Guidance
1. Established patient seen by provider (i.e., PCP, urgent care, or specialist) with symptoms concerning for COVID-19

Use standard evaluation and management CPT ® or HCPCS guidelines, including coding based on time.

2. Same as #1, but patient or provider cannot use secure video function. Use this scenario only when patient or provider cannot use secure video function. Secure video visit is always preferable to an audio-only visit. In this case, an audio visit can be used.  Use standard evaluation and management CPT ® or HCPCS guidelines, including coding based on time. Codes 99211-99215 plus Place of Service (02) and CR modifier for audio only encounter.
3. New patient seen by provider (i.e., PCP, urgent care, or specialist) with symptoms concerning for COVID-19

Use standard evaluation and management CPT ® or HCPCS guidelines, including coding based on time. Codes 99201-99205 plus Place of Service (02).  

4. Same as #3 new patient with symptoms concerning for COVID-19 but patient or provider cannot use secure video function.

Use standard evaluation and management CPT ® or HCPCS guidelines, including coding based on time. Codes 99201-99205 plus Place of Service (02) and CR modifier for audio only encounter.

5. Established patient was scheduled for a routine (non-COVID19 related) in-person outpatient visit but will now be seen for a virtual visit.  May be especially useful for patients who are high risk for serious illness per CDC guidance and consistent with strategy for social distancing. 

Use standard evaluation and management CPT ® or HCPCS guidelines, including coding based on time. Codes 99211-99215 plus Place of Service (02). 

6. Same as #5 routine (non-COVID19 related), but patient or provider cannot use secure video function. Use this scenario only when patient or provider cannot use secure video function. Secure video visit is always preferable to an audio-only visit. In this case, an audio visit can be used. Use standard evaluation and management CPT® or HCPCS guidelines, including coding based on time. Codes 99211-99215 plus Place of Service (02) and CR modifier for audio only encounter.
7. New patient seen by provider (i.e., PCP, urgent care, or specialist) to establish care (non-COVID19 related).

Use standard evaluation and management CPT ® or HCPCS guidelines, including coding based on time. Codes 99201-99205 plus Place of Service (02).  

8. Same as #7 new patient (non-COVID19 related), but patient or provider cannot use secure video function.

Use standard evaluation and management CPT ® or HCPCS guidelines, including coding based on time. Codes 99201-99205 plus Place of Service (02) and CR modifier for audio only encounter.

9. Patient seen by PCP provider for Medicare Annual Wellness Visit (AWV). Use standard HCPCS guidelines.  Codes G0438-G0439 plus Place of Service (02). If audio only, use Place of Service (02) and CR modifier. Include appropriate diagnosis codes for chronic conditions. Requires documentation of blood pressure, pulse, respiratory rate, height, and weight that should be documented during the benefit period.  
10. Patient seen by PCP provider for preventative service/wellness visit.

Use standard evaluation and management CPT ® or HCPCS guidelines, including coding based on time. Codes 99381-99397, 99401-99412 plus Place of Service (02).  If audio only, use Place of Service (02) and CR modifier.  Medicare Advantage does not cover 99401-99404.

11. Patient in hospital confirmed or suspected COVID-19 infection but now stable. Hospitalist sees patient virtually to minimize contact.

Use standard evaluation and management CPT ® or HCPCS guidelines, including coding based on time. Code for appropriate level of hospital inpatient or observation care, plus Place of Service (02).

12. Patient in hospital confirmed or suspected COVID-19 infection sees specialty consult through virtual visit.

Use standard evaluation and management CPT ® or HCPCS guidelines, including coding based on time. Codes 99251-99255 or G0406-G0408, plus Place of Service (02).  For Medicare Advantage must use G0406-G0408.

13. Patient to be seen by behavioral health provider virtually. Patient is practicing social distancing and reluctant to come into clinic.

Use standard evaluation and management CPT ® or HCPCS guidelines, including coding based on time. Codes may include but not limited to 90791-90792, 90832-90842, 90845, 90853, 90863,  99201-99215 plus Place of Service (02). 

14. Patient in ER with confirmed or suspected COVID-19 infection but stable.  ER provider sees patients virtually to minimize contact. Could apply to ER providers conducting visit to homebound patient, or offsite ER doctor seeing patient in the hospital

Use standard evaluation and management CPT ® or HCPCS guidelines. Codes 99281-99285, plus Place of Service (02).  This is based on history and complexity of decision making and outcomes.  For Medicare Advantage members use G0425-G0427, plus Place of Service (02).

 

Most current member benefits for Commercial and Blue Medicare products exclude reimbursement for CPT ® 99441-3 and 98966-8.  



Blue Cross NC invites provider systems and clinical leaders in telehealth to join a “Virtual Rounds: COVID-19 and Telehealth” on Friday, March 20, 2020, at 3 pm.  We invite leaders from provider systems and practices to learn about Blue Cross NC’s recent measures to expand telehealth services and share your strategies for virtual care response to COVID-19. Please register using this link.

Questions?
Blue Cross NC is committed to supporting providers during the COVID-19 pandemic. Please bookmark this page and review all the resources we have here to find answers to your questions. We update this page regularly based on questions we receive, so it's very likely we've answered your question, as well. However, if you can't find the answer here, please email us at COVID19questions@bcbsnc.com. We are experiencing a large volume of inquiries but will respond as soon as possible. 


 

Refill Medications Early* - Effective March 6, 2020

We have waived early medication refill limits on prescriptions. Member cost-sharing will apply as usual.  

  • Blue Cross NC will allow payment of 60-day supplies should a member request two refills at once.
  • We encourage a 90-day supply. Physicians can order via mail order or at a retail pharmacy.

No Prior Authorization and No Member Cost Share for COVID-19 Testing** - Effective March 6, 2020

Blue Cross NC will not require prior authorization for COVID-19 diagnostic testing. Providers must order the test and consult with the lab to determine appropriate sample collection and shipping protocols, where appropriate. Blue Cross NC will cover medically necessary diagnostic tests for COVID-19 that are consistent with Centers for Disease Control and Prevention (CDC) guidance at no cost share to members.

  • If you are a provider system that has test processing capability for COVID-19, please email COandI@bcbsnc.com to tell us. We would like to collect current procedures and instructions to share with our members.
  • If you are a provider system that will be using your own testing capability for COVID-19, please hold claims until after April 1, 2020. 
  • The following codes are available for use after April 1, 2020:
    • For non-CDC lab testing, use HCPCS code U0002. This allows laboratories to bill for non-CDC laboratory tests, for SARS-CoV-2/2019-nCoV (COVID-19).
  • The AMA released the CPT code 87635 that may be used by providers as another option to bill for testing for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) (Coronavirus disease [COVID-19]).

Blue Cross NC will waive prior authorization requirements for diagnostic tests and covered services that are medically necessary services, consistent with CDC guidance, for members diagnosed with COVID-19** - Effective March 6, 2020

You do not need a prior authorization to deliver medically necessary services for patients diagnosed with COVID-19. The World Health Organization (WHO) will release COVID-19 ICD-10 codes by October 1, 2020. In the interim, we will follow CDC/ICD-10-CM guidance on how to bill for services for members with COVID-19. You should use the following diagnostic codes in the primary and secondary fields:

Patient Condition What Codes to Use
Pneumonia: For a pneumonia case confirmed as due to the 2019 novel coronavirus (COVID-19)
  • J12.89 Other viral pneumonia; AND
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere
Acute Bronchitis: For a patient with acute bronchitis confirmed as due to COVID-19
  • J20.8, Acute bronchitis due to other specified organisms; AND
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere. 
Bronchitis not otherwise specified (NOS):  For a patient with bronchitis not otherwise specified due to the COVID-19
  • J40, Bronchitis, not specified as acute or chronic; AND
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere. 
Lower Respiratory Infection or Acute Respiratory Infection not otherwise specified (NOS): For a patient with COVID-19 is documented as being associated with a lower respiratory infection
  • J22, Unspecified acute lower respiratory infection; AND
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere.
Respiratory infection, not otherwise specified (NOS)
  • J98.8, Other specified respiratory disorders; AND
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

Acute respiratory distress syndrome (ARDS): For cases of ARDS due to COVID-19

  • J80, Acute respiratory distress syndrome; AND
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere. 
Possible Exposure but ruled out for COVID-19: For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation.
  • Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.

Actual Exposure to someone confirmed to have COVID-19

  • Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

*State Health Plan (SHP)members do not utilize Blue Cross NC pharmacy services and will follow the separate SHP prescription benefit policy.

**Please note that self-insured employer groups have the option to opt-in to this benefit. As such, some members may be ineligible for cost sharing coverage and waiver of prior authorization if their employers do not elect to cover these benefits. SHP has opted into these measures.

As a reminder, Blue Cross NC has a 30-day deferment policy to submit prior authorizations for any medically necessary services. If you submitted a claim for a service provided after March 6, 2020 that was denied due to lack of prior authorization, please re-submit your claim after March 21, 2020. Please note that you may choose to submit a prior authorization for review, even if one is not required by the health plan.

 

This article was originally published March 13, 2020.