As of 6/18/20 this communication has been updated with changes in red.
The safety and security of our members – and all Wyoming citizens – remains the top priority during these unprecedented times. Blue Cross Blue Shield of Wyoming (BCBSWY) remains committed to ensuring members can connect with providers.
Effective 3/20/2020, BCBSWY and the Federal Employee Program (FEP) will waive patient cost sharing for telemedicine services.
To ensure that the claim is properly processed we ask that all Physical, Occupational, and Speech Therapists add CPT code 99199 to their claims with a penny charge. All other providers can continue to bill based the guidance below.
BCBSWY will permit telephonic and telemedicine visits to occur to the patient’s home when the following conditions are met:
- The services provided are within the provider’s scope of license.
- Telecommunications technologies utilized must comply with applicable federal and state legal requirements of health/medical information privacy, including compliance with HIPAA.
- Services must be medically appropriate to be rendered at a distance.
- Providers should bill the service that they render with a GT modifier.
- Physical therapy, occupational therapy, and speech therapy should bill without the GT modifier.
- 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (21-30 minutes) will be permitted for telephonic visits. No GT modifier is required for these codes.
- These guidelines apply only to BCBSWY members. Providers should seek guidance from other Blues plans for potential changes to their policies.
- These guidelines do not apply to members of the Federal Employee Program.
- Other benefit and cost share rules will continue to apply. It is important to note that only services that can be rendered through telemedicine should occur. Effective 6/18/20, BCBSWY will waive cost share on all telemedicine services through 8/31/20.
- Services that cannot be safely or adequately provided through this means should be avoided.
- This policy will be reviewed and updated throughout the pandemic.
Common Questions – Telemedicine
1.) Which Place of Service (POS) codes should we use?
Providers should NOT use POS 2. Please use the same POS code as you would typically use for the service being rendered.
2.) Can I use modifier 95?
No, our system is currently configured to only use the GT modifier. Unlike CMS, if you use modifier 95 it will deny as billed in error.
3.) How much do you pay?
Reimbursement for services is no different than those rendered in the office.
4.) Do I bill an originating site?
No. Only the distant site (provider location) is reimbursable when the patient is at home.
5.) Where can I go for more FEP information?
Go to: www.fepblue.org/telehealth
6.) What codes can I bill?
Services provided via telemedicine need to be appropriate and safe to render at a distance. The standard of care must be met.
7.) Is it legal to perform telephonic services in Wyoming?
Yes, it is legal to perform telephonic services in Wyoming.
8.) What if the provider is out of state?
If the provider is an employee or subcontractor of a Wyoming provider, claims can be submitted to BCBSWY. If the provider is independent normal Blue Card rules apply and the claim should be processed to the Blue plan in the state the provider is located in.
9.) What if I am a provider working remotely?
Providers are permitted to work remotely at home, if the service provided replicates an office visit or telephonic visit similar to what would be done in the office, including medical record documentation.
10.) Can behavioral health services be provided via telemedicine?
Yes, therapy services can be provided via telemedicine if the standard of care is met.
11.) Is all cost-sharing waived during this time?
No, only the services pertaining to testing of COVID-19 waive cost shares. In-person visits regarding other medical diagnosis (i.e. psychological, substance abuse services, PT, OT, ST, etc) will continue to apply normal benefit cost sharing amounts. Effective 6/18/20, BCBSWY will waive cost share on all telemedicine services through 8/31/20.
- NEW GUIDANCE! BCBSWY will reimburse in person office visits, urgent care, and other outpatient visits including lab, emergency department, and imaging for COVID-19 without member cost share when one of the following appropriate ICD10 diagnosis codes is billed: Z03.818, Z20.828, B97.29, B34.2, or U07.1. This applies to both institutional and professional billing.
- BCBSWY will waive any cost-sharing, including co-pays, deductibles and co-insurance for CDC-recommended laboratory testing of COVID-19 so that the cost-sharing does not serve as a barrier to access these important tests. In addition to related testing procedures (flu panel, respiratory panels, RSV). BCBSWY encourages providers to use in-network laboratories for COVID-19 testing to reduce any member abrasion. Please reach out to email@example.com if you have any questions about the laboratory you are planning to utilize.
- Subsequent hospital stays associated with COVID-19 will be covered in accordance with the member’s current health benefit plan. Effective 4/1/20-8/31/20, BCBSWY is waiving all member cost sharing and copayments for inpatient hospital admissions due to the diagnosis of COVID-19 for all fully insured and FEP members and is optional for self-funded plans.
- Effective (3/10/20-6/30/20), BCBSWY is increasing access to prescriptions by allowing pharmacies to refill prescriptions earlier than typically allowed. In addition, most plans allow members to fill maintenance medications for up to a 90-day supply through local or mail-order pharmacies.
To ensure members have the medications they need on hand, BCBSWY now allows pharmacies to waive “refill too soon” limits on prescriptions
- Get email updates! Ask to be added to receive Provider Updates at firstname.lastname@example.org