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Updated! COVID-19 FAQs: Details Added for Medicare Providers

Posted May 29, 2020

As the COVID-19 crisis continues to evolve, Blue Cross and Blue Shield of Illinois (BCBSIL) is making changes to serve all our members. We’ve compiled answers to frequently asked questions (FAQs) we’ve received from providers, related to COVID-19.

Originally posted in April 2020, these COVID-19 Provider FAQs  have been updated. Among other changes, there’s a new section with Additional Information for Government Programs. Some highlights related to Medicare members are included below.

We’re following Centers for Medicare & Medicaid Services (CMS)  guidelines as appropriate. The Medicare information in our updated COVID-19 Provider FAQs includes details on:

Coverage for Testing, Testing-related Visits and Treatment
Medicare members won't pay copays, deductibles or coinsurance for:

  • Medically necessary lab tests to diagnose COVID-19 that are consistent with CDC guidance
  • Testing-related visits related to COVID-19 with in-network providers, including at a provider's office, urgent care clinic, emergency room and by telehealth
  • Treatment for COVID-19 with providers or at facilities from April 1 through June 30, 2020. This change may be extended if needed. Members should confirm whether their benefit plan covers services received from out-of-network providers. For questions about benefits, members may call the number on their ID card.

Expanded Access to Telehealth at No Cost-share
Medicare members can access in-network telehealth services at no cost-share for medically neessary, covered services and treatments consistent with the terms of the member’s benefit plan. Medicare Advantage PPO members have access to telehealth services with out-of-network providers but will be responsible for member cost-share for these services consistent with the terms of their plans. This cost-share waiver for telehealth services applies to claims beginning March 1, 2020.

Telehealth for Annual Health Assessments
Initial and subsequent Annual Wellness Visits (G0438 and G0439) for Medicare members may be conducted by telehealth. Submit claims for wellness visits with Modifier 95 and Place of Service (POS) 11. BCBSIL covers one wellness visit every calendar year. Note: CMS has not approved Initial Preventive Physical Examinations (IPPE) (G0402) for telehealth. Members are eligible for the IPPE during their first 12 months of enrollment in Medicare.

Reminders
To confirm Medicare members’ coverage and benefits, you may use the Availity® Provider Portal  or your preferred vendor. To verify telehealth coverage for Medicare Advantage members, call Provider Services at 877-774-8592 and speak with a Customer Advocate. For Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members, call 877-723-7702.

Resources

Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized/pre-notified is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, call the number on the member’s ID card.

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.