Additional Information About the Telehealth Policy for 2023

As communicated in our most recent Telehealth Policy update, Blue Cross NC will update its Telehealth Policy, effective Jan. 1, 2023, to significantly expand its list of covered telehealth services, compared to telehealth services covered prior to the pandemic. The new Telehealth Policy will continue to cover services that make up more than 97 percent of the telehealth claims received during the last two years, particularly behavioral health, primary care and outpatient office visits.  Please review the full details of the new telehealth policy taking effect in 2023.   

Additional information and key points include:

• The updated Telehealth Policy applies to approved telehealth services regardless of the software or platform the local provider is using to render the services via telehealth. For details regarding telehealth vendor coverage please refer to your member benefit booklet or contact customer service for eligibility information. 
  
• The new Telehealth Policy applies to all Blue Cross NC fully insured and administrative services only (ASO) plans, including the State Health Plan. It does not apply to Blue Cross NC members receiving care from providers located outside of North Carolina at the time of the care. Members who do not have a fully insured or ASO commercial plan can find more information about their telehealth coverage below. 
  • Medicare Advantage members should review their evidence of coverage.    
  • Healthy Blue members have certain telehealth visits covered at parity under Medicaid benefits determined by the state   
  • Federal Employee Program members can find details in their Service Benefit Plan Brochure.

Provider Frequently Asked Questions 

Where can I find more information on the telehealth codes that will be covered?  

Please review our Corporate Reimbursement Policy for Telehealth.  

Can facilities bill for telehealth services?  

All telehealth services must be billed through professional claims.  

How will Blue Cross NC reimburse providers for telehealth services?

Blue Cross NC will continue to pay non-facility rates for telehealth services, which reimburse at higher amounts when compared to facility rates. Audio-only telehealth services will receive 75 percent of the allowed reimbursement. 

How do I bill for telehealth services?

Telehealth services must be submitted on a professional claim with an appropriate modifier to distinguish between different forms of telehealth (synchronous vs asynchronous, audio vs audio/video, etc.).  

Telehealth services must be reported with place of service code 02 or 10.   

Place of Service: 02

Description: Telehealth Provided Other than in Patient’s Home 

Place of Service: 10 
Description: Telehealth Provided in Patient’s Home

Am I required to use a specific software or platform to provide telehealth services under the new policy?

The updated Telehealth Policy applies to approved telehealth services regardless of the software or platform the local provider is using to render the services via telehealth. For details regarding telehealth vendor coverage please refer to your member benefit booklet or contact customer service for eligibility information.