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Telemedicine and Telehealth Administrative Policy 22 Part III

Audience: All Providers

Excellus BlueCross BlueShield is updating the following administrative policy effective November 1, 2022, to further define coverage and billing guidelines under Telemedicine and Telehealth Part III. This policy is in line with Centers for Medicare & Medicaid Services (CMS), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) guidelines.

This policy will apply to all participating and non-participating practitioners and the Commercial (HMO, PPO, POS, ASO/ASC, and Indemnity), Medicare Advantage, New York State Government Programs (Medicaid Managed Care, Health and Recovery Plan (HARP) and Special Programs (Healthy New York and Essential Plan) lines of business. This policy will not apply to the Federal Employee Plan. 

Administrative Policy 22 – Telemedicine and Telehealth - Part III

The Health Plan will enforce the frequency of telemedicine services in accordance with CMS guidelines and/or CPT code descriptions/guidelines.

Example: CPT code 99421 - Physician or qualified health care professional online digital evaluation and management, for an established patient, for up to seven days, cumulative time during the seven days; 5-10 minutes, will only be reimbursed once every seven days.

Example: HCPCS code G2010 – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment, will not be reimbursed within these guidelines.

Note: Part I of this policy has been suspended during the COVID-19 Public Health Emergency in accordance with CMS guidelines.

This policy will be reviewed pre-payment and post-payment. Pre-payment review means claims are reviewed prior to payment. A pre-payment review results in an initial determination.

Post-payment review means that claims are reviewed after adjudication. A post-payment review may result in either no change to the initial determination or a revised determination.

This policy is a billing and reimbursement requirements and information policy. These services are subject to audit and policy updates at the discretion of Excellus BCBS. Members are held harmless for all denials resulting from this administrative policy.  You can access the individual policies here.

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