In response to the COVID-19 pandemic, Blue Cross and Blue Shield of New Mexico expanded access to telemedicine services to give our members greater access to care. The experience confirmed the importance of telemedicine in health care delivery. Members can access their medically necessary, covered benefits through providers who deliver services through telemedicine. Many of our members also have access to various telemedicine vendors, such as MDLIVE.

What's covered?

Telemedicine services will be provided consistent with the terms of the member's benefit plan. As of Jan. 1, 2021, for our state regulated fully insured HMO and PPO members and our self-funded employer group members, providers will be able to deliver expanded telemedicine services to BCBSNM members, including but not limited to services included on:

Our self-funded employer group customers make decisions for their employee benefit plans. Check eligibility and benefits for any variations in member benefit plans.

We recommend the following:

  • Consider telemedicine a mode of care delivery to be used when it can reasonably provide equivalent outcomes as face-to-face visits.
  • Choose telemedicine when it enhances the continuity of care and care integration if you have an established patient-provider relationship with members.
  • Integrate telemedicine records into electronic medical record systems to enhance continuity of care, maintain robust clinical documentation and improve patient outcomes.

Eligible members

Providers can use telemedicine for members with the following types of benefit plans. Care must be consistent with the terms of the member's benefit plan.

  • State-regulated and fully insured plans
  • Blue Cross Medicare Advantage (excluding Part D) and Medicare Supplement (see Medicare info below)
  • Self-funded employer group plans
  • Medicaid [see below]

We will continue to follow applicable state and federal requirements. 

Submitting claims

The provider submitting the claim is responsible for accurately coding the service performed.

Review our Clinical Payment and Coding Policy CPCP033, Telemedicine and Telehealth Services, for more information on submitting these claims.

Member cost share

As of Jan. 1, 2021, copays, deductibles and coinsurance apply to telemedicine visits for most members. The cost share varies according to the member's benefit plans. Check eligibility and benefits for each member for details. Cost share does not apply for covered telemedicine services for fully insured and IBAC members when such services are COVID-19 related testing or treatment.

Our self-funded employer group customers make decisions for their employee benefit plans and may choose to waive telemedicine cost share. Check eligibility and benefits for any variations in member benefit plans.

What's covered for Medicare Advantage and Medicare Supplement members

CMS identifies covered services for Medicare Learn more about third-party links members. This means we will cover all the CMS telemedicine codes Learn more about third-party links, including those available only during the PHE for Medicare Advantage and Medicare Supplement members.

For the duration of the PHE, we are waiving cost share for our Medicare Advantage members. This means these members will not owe any copays, deductibles or coinsurance for telemedicine visits. The cost share waiver does not apply to Medicare Supplement members.


We will follow the applicable guidelines of the New Mexico Health Care Authority and Centers for Medicare & Medicaid Services as appropriate for Medicaid.

The New Mexico Health Care Authority has added new codes for both medical and behavioral health services for New Mexico Medicaid members through 2024. These codes and payment rates can be found in the Special COVID-19 Letter of Direction #13 Learn more about third-party links.

Referrals and prior authorizations

Some telemedicine care will require referrals and prior authorizations in accordance with the member's benefit plan. Check eligibility and benefits for each member for details.

Delivery methods

Available telemedicine visits with providers include:

  • 2-way, live interactive telephone communication (audio only) and digital video consultations
  • Asynchronous telecommunication via image and video not provided in real-time (a service is recorded as video or captured as an image; the provider evaluates it later)
  • Other methods allowed by state and federal laws, which can allow members to connect with physicians while reducing the risk of exposure to contagious viruses or further illness

Delivery methods for Medicare members

  • Providers should use an interactive audio and video telecommunications system that permits real-time interactive communication to conduct telemedicine services. CMS permits audio only in limited circumstances. See the CMS website for designated audio-only codes Learn more about third-party links.

Providers can find the latest guidance on acceptable Health Insurance Portability and Accountability Act (HIPAA) compliant remote technologies issued by the U.S. Department of Health and Human Services' Office for Civil Rights in Action Learn more about third-party links.

Telemedicine Vendors

For state-regulated fully insured members, providers are not required to use a vendor for telemedicine services. For self-funded members, providers may be required to use specific vendors as outlined in the member's benefit plan.


Covered telemedicine claims for eligible members for in-network medically necessary health care services will be reimbursed at the same rate as in-person office visits for the same service. Submit claims with appropriate codes and modifiers. For claims using a specific telemedicine code, the applicable telemedicine reimbursement will apply.

Member benefit and eligibility assistance

Check eligibility and benefits for each member at every visit prior to rendering services. Providers may:

  • Verify general coverage by submitting an electronic 270 transaction through Availity® or your preferred vendor.
  • Connect with a Customer Advocate to check eligibility and telemedicine benefits by calling our Provider Customer Service Center at 1-800-451-0287.
  • For Medicare Advantage members, call Blue Cross Medicare Advantage Network Management at 972-766-7100.