In response to the COVID-19 pandemic, Blue Cross and Blue Shield of New Mexico (BCBSNM) 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.
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:
- The Centers for Medicare and Medicaid Services (CMS) permanent and temporary telehealth code list
- The American Medical Association (AMA) telehealth code list
- Applied behavior analysis (ABA) services
- Intensive outpatient program (IOP) services
- Partial hospitalization programs (PHP)
- Physician therapy (PT)
- Occupational therapy (OT)
- Speech therapy (ST)
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.
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
- Blue Cross Community CentennialSM (Medicaid Plans) [see below]
We will continue to follow applicable state and federal requirements.
The provider submitting the claim is responsible for accurately coding the service performed. Submit claims for medically necessary services delivered via telemedicine with the appropriate modifiers (95, GT, GQ, G0) and Place of Service (POS) 02.
- 95 – synchronous telemedicine (two-way live audio visual)
- GT – interactive audio and video telecommunications
- GQ – asynchronous
- G0 – telemedicine services for diagnosis, evaluation or treatment of symptoms of an acute stroke; G0 must be billed with one of the approved telemedicine modifier (GT, GQ or 95)
Note: If a claim is submitted using a telemedicine code, no modifiers are necessary. Only codes that are not traditional telemedicine codes require a modifier.
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 members. This means we will cover all the CMS telemedicine codes , 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 Human Services Department and Centers for Medicare & Medicaid Services as appropriate for Blue Cross Community CentennialSM (Medicaid Plans).
The New Mexico Human Services Department (HSD) has added new codes for both medical and behavioral health services for New Mexico Medicaid members for the duration of the PHE. These codes and payment rates can be found in the HSD Special COVID-19 Letter of Direction #13 .
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.
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 .
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 .
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.
Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association