Your safety and the safety of our members is important to us.
We are encouraging our members to use telehealth services to help reduce exposure in healthcare settings as well as prevent community spread.
How do providers bill for telehealth visits?
Capital Blue Cross contracted providers may schedule the visit with the member through the provider’s normal scheduling platform and instruct the member how to connect (through phone or video conference).
Capital Blue Cross’ Telehealth Reimbursement Policy (NR 30-026) was originally patterned after CMS telehealth payment guidelines in effect at that time. Given the current COVID-19 situation, Capital Blue Cross is temporarily adjusting our policy to allow providers (identified in the policy) to bill and receive reimbursement consistent with an in-person visit.
- This temporary policy change applies to our CHIP, individual, and commercial group members, from April 1, 2020 until further notice.
- For our Medicare Advantage membership, this change applies beginning March 6, 2020 until further notice.
To facilitate reimbursement
During the temporary change in the Network Reimbursement Telehealth Services Policy (NR 30-026), providers must identify the place of service (POS) they would bill had the visit occurred as a face-to-face visit. Providers should NOT use “02” as POS. They must also identify that it was a telehealth service by including Modifier 95 (Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System).
Eligible providers
In-network providers who are eligible to provide telehealth services:
- Physicians.
- Physician Assistants (PAs).
- Certified Nurse Midwives (CNMs).
- Clinical Nurse Specialist (CNA).
- Certified Registered Nurse Anesthetists (CRNAs).
- Certified Registered Nurse Practitioners (CRNPs).
- Clinical Psychologist (CPs).
- Clinical Social Workers (CSWs).
- Registered dietitian or nutrition professional.
- Licensed Clinical Social Worker (LCSW).
- Licensed Family and Marriage Therapist (LFMTs).
- Licensed Professional Counselors (LPCs).
- Licensed Social Worker (LSW).
Due to the COVID-19 health emergency, we have temporarily expanded our eligible telehealth services to also include:
- Physical Therapy, Occupational Therapy, Speech Therapy.
- Applied Behavioral Analysis (ABA).
- Intensive Outpatient Program (IOP).
- Partial Hospitalization Program (PHP).
- Pulmonary Rehab.
Are Capital Blue Cross members eligible for telehealth?
Yes. Capital Blue Cross, generally has and will continue to cover telehealth services with in-network providers. Members do not need to have our Capital Blue Cross VirtualCare benefit.
Please verify a member’s eligibility and benefits before providing telehealth services.
For Medicare members, we will continue to follow CMS guidelines for coverage of telehealth services.
