Using Telemedicine and Telehealth in Response to COVID-19

Updated April 17, 2020: End date for expansion of coverage extended to May 31, 2020

Updated June 30, 2020: End date for cost-share waiver extended to Aug. 31, 2020

Updated Aug. 10, 2020: End date for expansion of coverage extended to Dec. 31, 2020, and cost-share waiver extended to Sept. 30, 2020

Updated Sept. 29, 2020: End date for telemedicine cost-share waiver extended to Dec. 31, 2020

Blue Cross and Blue Shield of New Mexico (BCBSNM) is responding to the coronavirus (COVID-19) and expanding our coverage for medical and behavioral health telemedicine and telehealth visits through Dec. 31, 2020. We are also giving our members access to clinically appropriate medical and behavioral health services delivered through telemedicine with no copays or deductibles through Dec. 31, 2020. This will make it easier for members to access care while reducing their risk of exposure.

The cost-share waiver applies to all fully insured members whose benefit plan includes telemedicine. It applies to claims from March 9, 2020 through Dec. 31, 2020.

Note: Many of our members are covered under a health plan that is self-insured by their employer. The Families First Coronavirus Response Act was enacted on March 18, 2020, and requires these self-insured groups to provide benefit coverage for COVID-19 testing and related services  for dates of service on or after March 18, 2020. Some of these self-insured groups may choose to offer expanded coverage for telemedicine and telehealth visits between now and Dec. 31, 2020. Providers should always check member benefits prior to rendering service to confirm the member’s current benefit level.

Who can provide telemedicine?
BCBSNM in-network providers who offer the service through two-way, live interactive telephone (for the period of March 9 – Dec. 31, 2020, only) and/or digital audio and video consultations may provide telemedicine, based on state statutes. Some members have virtual visit benefits through MDLIVE^®.

What services can I deliver through telemedicine?
The following telehealth codes are accepted by BCBSNM for use by health care professionals including behavioral health therapy services:

New Mexico Only:

*Providers submitting claims for telemedicine services using these codes must append with modifier 95.

For now, ABA, physical therapy and other therapy services are not eligible for zero cost share.

The New Mexico Human Services Department (HSD) has added new codes for both medical and behavioral health services for New Mexico Medicaid members to encourage the use of telephonic visits and e-visits in lieu of in-person care to reduce the risk of spreading COVID-19 through face-to-face contact. These codes and payment rates can be found in HSD Letter of Direction (LOD) #30. 

Resources:
For more information refer to our Telemedicine and Telehealth Services Quick Reference Guide . BCBSNM will continue to evaluate the telehealth program to best serve our members.

Because this is a rapidly evolving situation, you should continue to use Centers for Disease Control guidance  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.

_{As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if benefit prior authorization is required for a member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSNM’s provider website.}

_{Please note that checking eligibility and benefits, and/or the fact that a service or treatment has been prior authorized or predetermined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member’s ID card.}

_{Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any products or services offered by Availity, Aerial or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.}

_{MDLIVE is a separate company that operates and administers Virtual Visits for Blue Cross and Blue Shield of New Mexico. MDLIVE is solely responsible for its operations and for those of its contracted providers. MDLIVE operates subject to state regulations and may not be available in certain states. MDLIVE is not an insurance product nor a prescription fulfillment warehouse. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services.}