California Physicians' Service DBA Blue Shield of California 1999-2023. We have added these codes to our COVID-19 Temporary payment policy. Since the vaccine is supplied free, Blue Cross will not reimburse separately for the vaccine, regardless of the modifier. Two COVID-19 updates effective July 1, 2021: Change to telehealth cost share and authorization requirements, Update to bamlanivimab pharmaceutical treatment for COVID-19, Lab claims must include ordering clinician NPI starting July 1, Medicare sequestration suspended through December 31, 2021, Were committed to reducing health care inequities, Revised reimbursement for COVID-19 vaccination administration codes available, Monthly communications aim to reduce vaccine hesitancy, Updated coverage guidelines for COVID-19 testing, Medicare Advantage telehealth cost share & COVID-19 vaccine billing, Updates to vaccine and pharmaceutical treatment codes for COVID-19, Blue Cross Blue Shield of Massachusetts joins national effort to help vaccinate seniors in underserved communities, Were helping to fund free rides for COVID-19 vaccine access, Provider reimbursement for COVID-19 vaccination administration codes are available, Facts may help patients understand and embrace COVID-19 vaccine, COVID-19 Information page updates: Cognitive rehab, testing coverage, and diagnosis codes, Updated billing guidelines and fees for COVID-19 lab testing codes, Telehealth and telephonic codes billing reminder, Updates to COVID-19 vaccine administration codes and pharmaceutical treatment, COVID-19 - Authorization requirements waived until March 31, Vaccines and pharmaceutical treatment for COVID-19, Updates to Medicare Advantage services effective Jan 1, Claims with COVID diagnoses require positive test in chart, COVID-19: Inpatient acute care auth requirements waived until Dec 31, COVID-19: Use appropriate diagnoses when billing for COVID testing, COVID-19: Coverage guidelines for laboratory tests, COVID-19: Coverage guidelines for pharmaceutical treatments, COVID-19: Auths extended; non-emergent transport modifiers, Dental Blue will offer assistance for PPE costs for dentists, Telehealth & online digital codes for FEP & Medicare Advantage, New supports for our members mental health, COVID-19: Continued coverage for early intervention services, COVID-19: Resuming provider audits and claim reviews, Increased fees for COVID-19 lab & specimen collection codes, COVID-19-We're extending our prior authorization waiver, Dental care strategies in the age of COVID-19, How were helping during COVID-19 emergency, COVID-19 payment policy, lab testing codes, claim reminders, COVID-19: APR-DRG Grouper ICD-10 code update, Patients with asthma can get early refill of their controller med, COVID-19: Extending authorizations for specific services, COVID-19: Expedited credentialing process; provider audits on hold, Non-emergency ground ambulance transports covered temporarily, COVID-19: How to bill for drive-through testing, Medicare Advantage reimbursement will be temporarily adjusted, Blue Cross Blue Shield of Massachusetts Telehealth Claims Skyrocket During Coronavirus Pandemic, Member costs waived for inpatient COVID-19 services, Chloroquine, hydroxychloroquine coverage update, Coverage for dental telephone or video consultations, Dentists and oral surgeons: How were helping during COVID-19 emergency, the original hydroxychloroquine policy still applies, Frequently Asked Questions on the Revocation of the Emergency Use Authorization for Hydroxychloroquine Sulfate and Chloroquine Phosphate (PDF, 125 KB), Massachusetts Standard Form for Medication Prior Authorization Requests, Medical Policy 660: Cognitive Rehabilitation, Notification of Enforcement Discretion for telehealth, use of reverse transcription-polymerase chain reaction (RT-PCR) or antigen testing to detect the presence of SARS-CoV-2 for a diagnosis of COVID-19 infection, Serologic testing for the presence of antibodies for known or suspected current or prior COVID-19 infection, Public Health Emergency Credentialing Application, Contact your local plan. Your insurance company will reimburse you for the full purchase price of each covered test. Your plan will provide this coverage through reimbursement to you. COVID-19 Testing Coverage Website: Coverage for out-of-network testing will change when the public health emergency ends. about potential out-of-pocket costs from out-of-network providers. Coverage for COVID-19 testing outside of the United States depends on your plan benefits and the reason for testing. Blue Cross and Blue Shield of Texas (BCBSTX) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). Reverse transcription-polymerase chain reaction (RT-PCR) or antigen testing to detect the presence of SARS-CoV-2 for the diagnosis of COVID-19 is covered when ordered by a health care provider who is making an individualized clinical assessment of the patient in accordance with current standards of medical practice. Network of Preferred Providers: Coverage is available when the pharmacy offers OTC COVID-19 tests and has them in stock. Members who already have coverage for problem-focused exams (D0140) will have no cost share (deductible, copayment, or co-insurance).*. To bill for services by phone Bill all covered services that you render as if you are performing an in-person service using the codes that are currently on your fee schedule. Use one of the following telehealth modifiers on all lines billed: GT, 95, G0, or GQ. This includes visits by phone and your communication platform of choice. I have a Medi-Cal plan. *These modifiers do not apply to Federal Employee Program members. We've taken steps to lower costs and provide our members easier access to care related to COVID-19. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R. Reimbursable for dates of service on or after April 14, 2020. Please choosein-network locationsfor testing to avoid paying any extra fees. Americans with private insurance will be able to ask for reimbursement for rapid COVID-19 tests beginning Saturday but any tests purchased before January 15 will not qualify. This will enable us to pay you the same rate we pay you for in-person visits. For example, a physician, a nurse practitioner, or a physician assistant. The provider should mail you a refund check. They are basically the same. They include: As Americans continue to monitor the coronavirus outbreak, one thing they should not be concerned with is whether Blue Cross and Blue Shield will be there for them, saidWilliam A. Breskin, senior vice president of government programs for the Blue Cross Blue Shield Association. As of April 4, 2022, the Centers for Medicare & Medicaid Services (CMS) is covering up to eight free OTC COVID-19 at-home tests each calendar month at participating pharmacies and healthcare providers. For help with these documents, please call 1-800-975-6314. . Billing for partial hospitalization and intensive outpatient using telehealth. Beginning on January 1, 2022, sequestration will be reinstituted. Learn more about the different types of tests. For help with these documents, please call 1-800-975-6314. . We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. Several drugs are under investigation as potential treatments for COVID-19 that have shown early benefit in clinical trials. We extended the filing limit for initial claim submissions. Viral testing Members should call the number on the back of their ID card. Network of Preferred Providers: Vaccine and vaccine administration codes for COVID-19. For Federal Employee Program and Medicare Advantage members, coverage for these drugs remains the same at this time. 12When the public health emergency ends, all out-of-network costs not paid by Blue Shield will be your responsibility. This is at the discretion of the prescriber and/or dispensing pharmacist. This information is provided for informational purposes only. The member will be responsible for any unrelated fees charged by an out-of-network provider. You must use one of the following telehealth modifiers listed above (GT, 95, G0, and GQ) and the applicable place of service code. Well allow the use of these modifiers for any service on your fee schedule. Members will be required to fill out a COVID-19 self-test claim submission sheet and submit it via us mail along with UPC packaging label and receipt. Reimbursement is limited to $12 per test, which may include tax and shipping/delivery charges (to a maximum of $12). For more information about HSAs, eligibility, and the laws current provisions, you should ask your financial or tax adviser, or check with your HSA administrator for more details. Blue Cross and Blue Shield companies (BCBS) will also increase access to prescription drugs, enhanced telehealth and other clinical support . The Massachusetts Division of Insurance (DOI) issued aMarch 26, 2020 Bulletinaddressing this topic. Please be aware that this statement is. For PPO/Insurance Company inquiries, please call 517-364-8456 or (toll-free) 800-203-9519. This includes the Centers for Disease Control (CDC) and the Massachusetts Department of Public Health (DPH) guidelines. These tests are available without out-of-pocket cost at locations specified by your insurance company. OTC at-home tests must have been purchased on or after January 1, 2022. In that case, you would be able to submit reimbursement for up to four packages, or eight tests total, for each member on your plan. . Please note that Blue Shield does not offer tax advice for HSAs. Blue Shield of California PO Box 272540 Chico, CA 95927-2540 COVID-19 laboratory tests (PCR tests) If you paid out of pocket for a test that was sent to a laboratory, follow the steps below to file a reimbursement claim. COVID-19 Testing Coverage Website: Please note that Blue Shield does not offer tax advice for HSAs. Members should complete the OptumRx Over-the-Counter Test Reimbursement Form and include their receipts. Call the customer service number on your member ID card. When reporting the telehealth modifier, if applicable, please place the telehealth modifier after the license modifier. (Medical and Mental Health) Network Management and Credentialing Services You may also call the customer service phone number on your member ID card. If you did not receive a refund from your provider, please contact their office. The program is . Rheumatological and dermatological use *The CDC has created an interim set of ICD-10 CM official coding guidelines, effective February 20, 2020. 8*Self-funded group plan antibody tests are covered when ordered by a provider unless the group has opted in to offer coverage in alignment with SB 510. Staying up to date with COVID-19 vaccinations protects against the worst outcomes of COVID-19. If your provider has not submitted a claim to Blue Shield for you,visit our How to file a claim pageto learn more. For information about your insurer's reimbursement process, see the information below. We will continue to waive the authorization requirement for commercial and Medicare Advantageinitial requestsfor the following serviceswith a COVID diagnosis: If you arent already, please submit clinical information for all authorization requests with the exceptions noted above. www.bcbsm.com/coronavirus. Insurers may not apply deductibles, co-pays, or other cost sharing to at-home COVID-19 tests purchased under this new benefit. For some plans, only emergency and urgent care are covered outside of the United States. Members who filled a prescription for rheumatological and dermatological use within the previous 180 days are excluded from the quantity limit. In 2020, we extended time-limited authorizations through the end of the year for specific outpatient procedures that our members may not have been able to receive due to the COVID-19 emergency. * Login to find out what options are available to you. All rights reserved. Licensed independent clinical social worker, Psychiatric and state psychiatric hospital. Blue Shield and Blue Shield Promise cover these types of tests: 1Tests ordered by a healthcare provider means that a licensed and authorized healthcare provider has requested that you obtain a test for COVID-19. If you purchase an over-the-counter COVID-19 test from a pharmacy, store, or online retailer and are charged for your test, keep your receipt and submit a claim to Cigna for reimbursement. COVID-19 testing, counseling, vaccination & treatment. Note: Telephonic codes (98966-98968, 99441-99443) do not require the use of any telehealth modifier. Phone Number: Over-the-counter tests for things like return to work or school, travel and recreational event requirements may not be covered unless you have symptoms or have been exposed. For example, a physician, a nurse practitioner, or a physician assistant. Serologic testing for the presence of antibodies for known or suspected current or prior COVID-19 infection is covered for FDA-approved tests when ordered by any healthcare professional authorized under state law. If a member purchases a kit from an out-of-network provider or retailer, the member must submit a member reimbursement form.