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Using Telemedicine and Telehealth in Response to COVID-19

March 30, 2020

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


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. We are also giving our members access to clinically appropriate medical and behavioral health services delivered through telemedicine with no copays or deductibles through Aug. 31, 2020. This will make it easier for members to access care while reducing their risk of exposure.

The expanded benefit applies to all fully insured members whose benefit plan includes telemedicine. It applies to claims from March 9, 2020 through Aug. 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 Aug. 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 – Aug. 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:


Code

Description

90791*

Psych diagnostic evaluation

90792*

Psych diagnostic evaluation w/medical services

90832*

Psychotherapy 30 min

90833*

Psychotherapy 30 min w/e&m evaluation

90834*

Psychotherapy 45min

90836*

Psychotherapy 45 min w/e&m evaluation

90837*

Psychotherapy 60min

90838*

Psychotherapy 60min w/e&m evaluation

90847*

Family psychotherapy

99213*

Office visit established patient 15 min

99214*

Office visit established patient 25 min

99215*

Office visit established patient 40 min

99421

Physician /Qualified Health Professional telephone evaluation 5-10 min

99422

Physician /Qualified Health Professional telephone evaluation 11-20 min

99423

Physician/Qualified Health Professional telephone evaluation 21-30 min

99441

Physician/Qualified Health Professional online digital evaluation 5-10 min

99442

Physician/Qualified Health Professional online digital evaluation 11-20 min

99443

Physician/Qualified Health Professional online digital evaluation 21-30 min

98966

Nonphysician telephone assessment 5-10 min

98967

Nonphysician telephone assessment 11-20 min

98968

Nonphysician telephone assessment 21-30 min

98970

QNHP online digital E/M SVC EST PT <7 D 5-10 min

98971

QNHP online digital E/M SVC EST PT <7 D 11-20 min

98972

QNHP online digital E/M SVC EST PT <7 D 21+ min

 

New Mexico Only:


99451

NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5/> MIN

99452

NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30 MIN

G2010

Remote image submit by pt

G2012

Brief check in by md/qhp

G2061

Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes

G2062

Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes

G2063

Qualified nonphysician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes

90839

PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES

90840

PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES

90846

FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS

90849

MULTIPLE FAMILY GROUP PSYCHOTHERAPY

90853

GROUP THERAPY

90863

PHARMACOLOGICAL MANAGEMENT

H0049

Alcohol/drug screening

H0050

Alcohol/drug service 15 min

G0175

OPPS Service, sched team conf

S0220

Medical conference by physic

G0444

ANNUAL DEPRESSION SCREENING, 15 MINUTES

G0443

BRIEF FACE-TO-FACE BEHAVIORAL COUNSELING FOR ALCOHOL MISUSE, 15 MINUTES

G0406

Inpt/tele follow up 15

G0407

Inpt/tele follow up 25

G0408

Inpt/tele follow up 35

H0015

Alcohol and/or drug services

H0025

Alcohol and/or drug preventi

H0031

MH health assess by non-md

H0038

Self-help/peer svc per 15min

H0039

Asser com tx face-face/15min

H2000

Comp multidisipln evaluation

H2011

Crisis interven svc, 15 min

H2015

Comp comm supp svc, 15 min

H2033

Multisys ther/juvenile 15min

T1000

Private duty/independent nsg

T1001

NURSING ASSESSMENT EVALUATION

T1007

TREATMENT OR SERVICE PLAN UPDATE DEVELOPMENT

90785

PSYCHOTHERAPY COMPLEX INTERACTIVE

99201

OFFICE OUTPATIENT NEW 10 MINUTES

99202

OFFICE OUTPATIENT NEW 20 MINUTES

99203

OFFICE OUTPATIENT NEW 30 MINUTES

99204

OFFICE OUTPATIENT NEW 45 MINUTES

99205

OFFICE OUTPATIENT NEW 60 MINUTES

99211

OFFICE OUTPATIENT VISIT 5 MINUTES

99212

OFFICE OUTPATIENT VISIT 10 MINUTES

99217

OBSERVATION CARE DISCHARGE MANAGEMENT

99218

INITIAL OBSERVATION CARE/DAY 30 MINUTES

99219

INITIAL OBSERVATION CARE/DAY 50 MINUTES

99220

INITIAL OBSERVATION CARE/DAY 70 MINUTES

99221

INITIAL HOSPITAL CARE/DAY 30 MINUTES

99222

INITIAL HOSPITAL CARE/DAY 50 MINUTES

99231

SBSQ HOSPITAL CARE/DAY 15 MINUTES

99232

SBSQ HOSPITAL CARE/DAY 25 MINUTES

99233

SBSQ HOSPITAL CARE/DAY 35 MINUTES

99241

OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN

99242

OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN

99243

OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN

99244

OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN

99245

OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN

99406

TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES

99407

TOBACCO USE CESSATION INTENSIVE >10 MINUTES

 

 

 

Revenue Codes

0513

Crisis Triage Center (CTC) Non-residential (NM Medicaid)

0728

Revenue Code For FQHCs, RHCs, HBRHCs, & IHS

 

*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. Learn more about third-party links

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 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.


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.