Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has covered telehealth for more than 20 years, expanding our policy at the onset of the pandemic and continuing to cover virtual visits the same as in-person visits. Blue Cross NC is updating its current Telehealth Medicare Advantage reimbursement policy to continue to provide additional telehealth coverage beyond Centers for Medicare & Medicaid Services (CMS) as described below and on the CMS website.

Prior to October 1, 2025, the federal government (CMS) allowed reimbursement of telehealth services for non-behavioral / mental health care in their home. Beginning October 1, 2025, Medicare patients can permanently receive telehealth services for behavioral / mental health care in their home. However, Medicare patients must be in an office or medical facility located in a rural area (in the U.S.) for most other telehealth services.

The updated Blue Cross NC Telehealth Policy will continue to cover additional services, including behavioral health, primary care, and outpatient office visits. Blue Cross NC continues to study telehealth data and will update its policy in the future to best serve members and ensure that telehealth remains a tool that improves health and increases access to affordable health care.

Blue Cross NC will continue to require providers to submit Telehealth services using the existing code plus modifier combination to distinguish between asynchronous vs synchronous, audio vs audio / video, etc. as described in our Telehealth Medicare Advantage reimbursement policy. Therefore, no changes are needed to the way providers code the Telehealth services they provide. To ensure accurate reimbursement, we may deny or request refunds for telehealth services that are not billed correctly. Please refer to this provider news for additional information on some non-reimbursable Telehealth CPT codes.

The policy applies to all Medicare Advantage plans offered and administered by Blue Cross NC. The extended policy does not apply to Blue Cross NC members getting care from out-of-state providers. Providers may continue to use the platform of their choosing for telehealth services.