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Blue Cross and Blue Shield of Illinois Further Expands Telehealth in Response to COVID-19

Posted March 18, 2020

Please Note: Additional updates have been made to our telehealth program as of March 28, 2020. Learn more.

Blue Cross and Blue Shield of Illinois (BCBSIL) is responding to the coronavirus (COVID-19) pandemic by offering additional coverage for telehealth visits to give members improved access to care while reducing their risk of exposure.

Effectively immediately, BCBSIL will accept telehealth billing codes for additional services, including behavioral health therapy, as described in the table below. This expansion is in addition to the new telehealth program announced on March 11, 2020, and applies to eligible BCBSIL PPO and Blue Choice PPOSM members for medically necessary services with an in-network Illinois provider who offers telehealth services. Telehealth benefits for medically necessary services are also available to HMO members (in accordance with the details of their health plan) from providers in their medical group who offer telehealth. BCBSIL will continue to follow the applicable guidelines of the Illinois Department of Human Services and Centers for Medicare & Medicaid Services (CMS) as appropriate for Blue Cross Community Health PlansSM (BCCHPSM) (Medicaid Plans), Blue Cross Community MMAI Plans (Medicare-Medicaid Plan)SM and Blue Cross Medicare Advantage (PPO)SM members.

BCBSIL is also temporarily lifting cost-sharing for medically necessary health services delivered via telehealth. This applies to all fully insured members whose benefit plan includes telehealth benefits.

Benefits may be different for our members covered under certain employer-funded health plans, depending on the decisions their employer makes about telemedicine.

Between now and April 30, 2020, BCBSIL will continue to consider whether to extend the timeframe of this temporary cost-sharing change.

BCBSIL will continue to evaluate the telehealth program and make adjustments to best serve our members.

The following telehealth codes are now accepted by BCBSIL for use by health care professionals1 authorized by Illinois State law to provide services via telehealth:

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 60 min

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 online digital evaluation 5-10 min

99422

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

99423

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

99441

Physician /Qualified Health Professional telephone evaluation 5-10 min

99442

Physician /Qualified Health Professional telephone evaluation 11-20 min

99443

Physician/Qualified Health Professional telephone 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

*Providers submitting claims for telehealth services using these codes must append with modifier 95.

Available telehealth visits with BCBSIL providers currently include 2-way, live interactive telephone communication and digital video consultations, which can allow members to connect with physicians while reducing the risk of exposure to contagious viruses or further illness.

As a reminder, it’s critical to check eligibility and benefits for each member at every visit prior to rendering services. Providers may connect with a Customer Advocate to check eligibility and telehealth benefits via phone, or verify general coverage by submitting an electronic 270 transaction via the Availity® Provider Portal or other preferred vendor portal. This step will help providers determine coverage information, network status, benefit preauthorization/pre-notification requirements and other important details.

Continue to watch the News and Updates section of the BCBSIL Provider website for more information. For the most up-to-date information about COVID-19, visit the CDC website.

1 Under current Illinois law, "health care professional" includes physicians, physician assistants, optometrists, advanced practice registered nurses, and clinical psychologists licensed in Illinois, prescribing psychologists licensed in Illinois, dentists, occupational therapists, pharmacists, physical therapists, clinical social workers, speech-language pathologists, audiologists, hearing instrument dispensers, and mental health professionals and clinicians authorized by Illinois law to provide mental health services.

Checking eligibility and benefits and/or obtaining preauthorization/pre-notification is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any preauthorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.