Telemedicine Services Matrix
Effective Jan. 1, 2023, BCBSWY has updated our telemedicine guidance. BCBSWY will permit telephonic and telemedicine visits to occur at the patient’s home. Inpatient telemedicine encounters are permitted within the same facility. The below guidance is intended to assist professional providers understand the types of services permitted during this time. 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. Services that cannot be safely or adequately provided through telemedicine should be avoided. These guidelines apply only to BCBSWY members. Providers should seek guidance from other Blues plans for potential changes to their policies.
Please refer to the Provider Manual for more detailed guidance here.
| Type of Service | What is the Service | HCPCS/CPT Codes | Place of Service/Modifiers | Coverage |
|---|---|---|---|---|
| Inpatient (Professional Services) Telehealth/Telemedicine Visits | A service that can safely and appropriately be rendered at a distance. Services provided should be within the provider’s scope of license and meet the standard of care. Inpatient telemedicine encounters within the same facility are permitted. | HCPCS or CPT code(s) that can safely and appropriately be rendered at a distance as determined by BCBSWY. | Append a GT or 95 modifier as applicable with correct coding. Bill with the place of service of inpatient hospital. | BCBSWY covers telemedicine services subject to member’s benefits. |
| Outpatient (Professional Services) Telehealth/Telemedicine Visits | A service that can safely and appropriately be rendered at a distance. Services provided should be within the provider’s scope of license and meet the standard of care. Services can be rendered to the patient’s home. | HCPCS or CPT code(s) that can safely and appropriately be rendered at a distance as determined by BCBSWY. | Append a GT or 95 modifier as applicable with correct coding. | BCBSWY covers telemedicine services subject to member’s benefits. |
| Telephone Services | Telephone evaluation and management service by a physician or other qualified health professional for an established patient. | 99441 99442 99443 | Use standard place of service codes. The GT or 95 modifier is not required. | BCBSWY will benefit these services. |
| e-Visits | Online digital services for an established patient, through an online patient portal. | 99421 G2061 99422 G2062 99423 G2063 | Not applicable. | Not a benefit. These codes are not reimbursed by BCBSWY at this time. |
| Virtual Check-Ins | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient. | G2010 G2012 | Not applicable. | Not a benefit. These codes are not reimbursed by BCBSWY at this time. |
| Hospital Staff Mental Health and Substance Use Treatment | Diagnosis, evaluation, or treatment of a mental health or substance use disorder provided remotely by hospital staff who are licensed when the patient is in the home place of service. | C7900 C7901 C7902 | Not applicable. | BCBSWY will deny these codes as included in. Provider should bill the specific service rendered on a professional claim (HCFA-1500, 837P) with a GT or 95 modifier. You must bill with the national place of service 10 (Telehealth Provided in Patient Home). |
| Home Health Telemedicine | Home health services rendered using audio and/or video telecommunications including remote monitoring. | G0320 G0321 G0322 | Not applicable. | BCBSWY will deny these codes as included in. Provider should bill the specific service rendered on a professional claim (HCFA-1500, 837P) with a GT or 95 modifier. You must bill with the national place of service 10 (Telehealth Provided in Patient Home). |
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