As communicated in our most recent Telehealth Policy update, Blue Cross NC updated its Telehealth Policy effective January 1, 2023. Please refer to the revised telehealth policy for full details.
Please note, if a telehealth claim was filed incorrectly after January 1, 2023, refer to this provider news with information about filing a corrected claim.
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?
Our Corporate Reimbursement Policy for Telehealth can be found here.
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.
