Provider Information on COVID-19 Coverage

Updated May 19, 2020
Updated June 30, 2020

Blue Cross and Blue Shield of New Mexico (BCBSNM) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). We’ve taken steps to lower costs and provide our members easier access to care related to COVID-19.

Testing and Treatment Coverage

We are currently covering testing to diagnose COVID-19 for our members with no prior authorization needed and no member copays, deductibles or coinsurance. Testing coverage include tests for pneumonia and influenza with no member cost share. We also cover testing-related visits with in-network providers with no member copays, deductibles or coinsurance.

For treatment of COVID-19, we are temporarily waiving member cost-sharing, including copays, deductibles and coinsurance. The waiver applies to cost-share associated with COVID-19 treatment with providers, including facilities, from April 1 to Aug. 31, 2020 so long as the treatment is provided and consistent with the terms of the member’s benefit plan. We will reassess this waiver as events warrant. This includes the following members:

  • Fully insured employer-based (cost share waiver not limited to in-network)
  • IBAC (cost share waiver not limited to in-network)
  • Medicare (excluding Part D)
  • Medicare Supplement members
  • Medicaid members

Some members may not have access to out-of-network benefits. In addition, if members receive treatment at out-of-network providers, any cost-share waiver does not protect a member from provider balance or surprise billing. Members may be subject to balance or surprise billing depending on their benefit terms and state or federal laws since a provider may not accept the amount covered under the benefit plan as payment in full.

Follow our “COVID-19 Coverage for Members” web page for updates.

Note on self-insured groups: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may be responsible for copays, deductibles, or coinsurance for treatment of COVID-19 based on whether their employer chooses to participate in this benefit.

Medicare members: Medicare (excluding Part D) and Medicare Supplement members won't pay copays, deductibles or coinsurance for:

  • Medically necessary lab tests to diagnose COVID-19 that are consistent with CDC guidance
  • Testing-related visits related to COVID-19 with in-network providers, including at a provider's office, urgent care clinic, emergency room and by telehealth
  • Treatment for COVID-19 with providers or at facilities from April 1 through Aug. 31, 2020

Blue Cross Group Medicare SupplementSM and Blue Cross Medicare SupplementSM members do not have network restrictions unless otherwise noted on their plans.

Members should always call the number on their ID card for answers to their specific benefit questions. See our FAQs for Medicare Providers PDF Document for more details.

Check Member Eligibility and Benefits

Use the Availity® Provider Portal Learn more about third-party links or your preferred vendor for eligibility and benefit verifications.

Claims for COVID-19 Testing

If you test a member when it's medically appropriate and in accordance with generally consistent medical standards, submit the claim to us using the appropriate code. Member cost-share will be waived. COVID-19 testing should be authorized by the Food and Drug Administration (FDA), which includes Emergency Use Authorization (EUA).

COVID-19 Lab Codes

  • 0202U (infectious disease - bacterial or viral respiratory tract infection, pathogen-specific nucleic acid - DNA or RNA, 22 targets including severe acute respiratory syndrome coronavirus 2 - SARS-CoV-2, qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected)
  • 87635 (American Medical Association (AMA) code for SARS-2-CoV-2 lab test)
  • C9803 (Hospital outpatient clinic visit specimen collection for SARS-2-CoV-2)
  • G2023 (Specimen collection for SARS-CoV-2)
  • G2024 (Specimen collection for SARS-CoV-2 from an individual in a skilled nursing facility or by a laboratory)
  • U0001 (CDC testing laboratories to test patients for SARS-CoV-2)
  • U0002 (Non-CDC lab test)
  • U0003 (nucleic acid, amplified probe technique for SARS-2-CoV-2, making use of high throughput technologies)
  • U0004 (any technique, making use of high throughput technologies)

COVID-19 Diagnosis Codes

  • U07.1 (COVID-19 acute respiratory disease)
  • B97.29
  • B34.2
  • Z03.818 (possible exposure to COVID-19)
  • Z20.828 (actual exposure to COVID-19)

Modifier CS

For services furnished on March 18, 2020, through the end of the Public Health Emergency, use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing waiver for COVID-19 testing-related services.

COVID-19 Testing Before Treatment or Procedures

For COVID-19 testing provided before treatment or procedures, bill the test separately from the rest of the services being rendered. By doing this, we will ensure our members receive the cost-share waiver for COVID testing and the claim will be processed promptly. The appropriate benefits will apply to the remainder of each member’s non-COVID related care.

COVID-19 Antibody Testing

Submit claims for COVID-19 antibody testing to us using the appropriate code. Member cost-share (copay, deductibles and coinsurance) will be waived for antibody tests that are FDA authorized, including tests with EUA during the public health emergency.

Antibody Testing Requirements

Antibody tests must be FDA-authorized, including EUA. Antibody testing should be medically appropriate for the member and ordered by a health care professional. We encourage members to consult with their health care provider to determine the best test clinically indicated for their condition. Refer to the current FDA position on antibody testing Learn more about third-party links.

At-Home Antibody Tests

We cover at-home collection methods for antibody testing if the tests are FDA-authorized and are clinically indicated for the member. We encourage members to consult with their healthcare provider to determine whether the test is medically appropriate for their condition.

COVID-19 Antibody Testing Codes

  • 86318 (revised to indicate immunoassay for infectious agent antibodies; single-step method)
  • 86328 (new for COVID-19; single-step method)
  • 86769 (new for COVID-19; multi-step method)

For more detail on COVID-19 coding and guidance, refer to the American Medical Association Learn more about third-party links website or the Centers for Disease Control and Prevention Learn more about third-party links.

Out-of-Network Providers

If you are not in our networks, we will reimburse the cash price for COVID-19 diagnostic testing and antibody testing posted on your public website. This is the case except for fully insured and IBAC members who fall within the scope of the OSI’s rule on cost share waiver. That rule dictates that reimbursement will be made pursuant to New Mexico’s Surprise Billing Protection Act.

Telehealth

Many members have telehealth benefits. For those members, telehealth visits will be covered as a regular office visit for providers who offer the service through 2-way, live interactive telephone or digital video consultations. Some plans also provide access to MDLive, a vendor with a network of physicians who provide telehealth services. (Note: MDLive is not available for Medicare members.) For more details, refer to the Using Telemedicine and Telehealth in Response to COVID-19 article in News and Updates.

Pharmacy

For members who have BCBSNM pharmacy benefits administered through Prime Therapeutics, BCBSNM will allow members to receive an early fill of their medication for the same quantity as the last prescription filled. We also encourage members to use their 90-day mail order benefit, if applicable. All pharmacy practice safety measures, as well as prescribing and dispensing laws, will remain.

We are also prepared for medication shortages or access issues. Patients will not be liable for additional charges that may stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues.

Note on Medicare members: Members of these plans can get 90-day fills through mail order:

  • Blue Cross Group Medicare Advantage (HMO)SM
  • Blue Cross Group Medicare Advantage (PPO)SM
  • Blue Cross Group Medicare Advantage Open Access (PPO)SM
  • Blue Cross Group MedicareRx (PDP)SM
  • Blue Cross Medicare Advantage HMO/HMO SNP
  • Blue Cross Medicare Advantage HMO/HMO POS
  • Blue Cross Medicare Advantage (PPO)SM
  • Blue Cross Medicare Rx (PDP)SM
  • Blue Cross Medicare Advantage Dual Care (HMO SNP)SM

Credentialing Process Simplified for COVID-19

BCBSNM is temporarily updating our credentialing policy and processes in response to the COVID-19 emergency. This complies with emergency state and federal regulations and is effective April 3, 2020. The temporary modifications are only in place during the COVID-19 emergency and subject to change based upon state and federal action. Otherwise, standard credentialing and processes will apply.

What’s Changing? We are simplifying the process of joining our network.

Subject to state actions on licensing and practice requirements, we will credential providers who meet the following conditions for the duration of the state-declared emergency or as specified by state requirements:

  • We will accept practitioners who hold a full unrestricted license to practice granted by any state subject to the state’s emergency provider licensure laws. We will accept temporary licenses.
  • We will waive accreditation requirements, CMS certification and site visits for institutional providers.
  • We will accept expired documents if they have been inactive or expired for less than six-months and the provider is unable to obtain a current document from the issuer due to the COVID-19 emergency. Licenses, accreditations or certifications that have been revoked for cause will not be accepted.

Credentialing criteria and verification sources may change. Please check back often for updates

What is the risk of COVID-19?

According to recent reports from the CDC, the infection rate from COVID-19 is a rapidly evolving situation. The risk assessment may change daily. The latest updates are available on the CDC’s Coronavirus Disease 2019 (COVID-19) website. We are ready to help you serve our members and the community in understanding, preventing and potentially treating people who have been affected by COVID-19.

We've developed a member-facing flier about COVID-19 PDF Document that you may share with your patients.

More Information

Because this is a rapidly evolving situation, you should continue to use Centers for Disease Control guidance Learn more about third-party links on COVID-19, as the CDC has the most up-to-date information and recommendations. In addition, watch for updates on BCBSNM News and Updates.

If you have any questions or if you need additional information, please contact your BCBSNM Provider Relations Representative.

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