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Telehealth Visits – Medicare Advantage

August 31, 2020

Telehealth can help provide our members access to the care they need, including routine care, while helping to protect against the spread of viruses. Due to the COVID-19 Public Health Emergency, Blue Cross and Blue Shield of New Mexico (BCBSNM) has expanded access to telehealth at no cost-share* for our Medicare Advantage members through Dec. 31, 2020.
See our FAQs for Medicare Providers for more information.

The Centers for Medicare & Medicaid Services (CMS) is allowing providers to engage in telehealth services with new and established Medicare patients. Visit the CMS website for telehealth guidance Learn more about third-party links and a complete list of telehealth codes Learn more about third-party links.

Telehealth Visits

CPT®/ HCPCS Codes1

Modifier/Place of Service (POS)

Telehealth visits offer the same services that would be provided during an in-person visit.

They are conducted with an interactive audio and video telecommunications system** that permits two-way, real-time communication,2 including:

  • HIPAA-approved telehealth platforms such as MDLIVE®
  • Non-HIPAA-approved applications such as FaceTime and Skype

Telehealth visits for in-network, medically necessary covered health care services are reimbursed at the same rate as in-person visits.

Common services include:

  • 99201-99215 (Office or other outpatient visit)
  • G0438, G0439 (Medicare Annual Wellness Visit)
  • G0425-G0427 (Telehealth consultations, emergency department or initial inpatient)
  • G0406-G0408 (Follow-up inpatient telehealth consultations to beneficiaries in hospitals or skilled nursing facilities)

Report the POS code that would have been reported had the service been provided in person.

  • Include CPT telehealth modifier 95
  • You can also report POS 02 with no modifier

*BCBSNM Medicare (not Part D) and Medicare Supplement members can access in-network telehealth services at no cost-share for medically necessary, covered services and treatments consistent with the terms of the member’s benefit plan. Services available for telehealth may vary. Providers may call the number on the member ID card with questions.

**Providers can find the latest guidance on acceptable 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

Current Procedural Terminology (CPT) is a registered trademark of the American Medical Association

1 Centers for Medicare and Medicaid Services (CMS) interim final rule and comment period (IFC), 136, https://www.cms.gov/files/document/covid-final-ifc.pdf Learn more about third-party links

2 CMS interim final rule and comment period (IFC), 49, https://www.cms.gov/files/document/covid-final-ifc.pdf Learn more about third-party links

MDLIVE, an independent company, operates and administers the virtual visit program and is solely responsible for its operations and that of its contracted providers. MDLIVE® and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without written permission.

Learn more about third-party links By clicking this link, you will go to a new website/app (“site”). This new site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy.

File is in portable document format (PDF). To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader® which has a built-in screen reader. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com Learn more about third-party links.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.