May 3, 2022
Blue Cross and Blue Shield of Illinois (BCBSIL) has updated its telehealth reimbursement guidelines for commercial claims due to recent Centers for Medicare & Medicaid Services (CMS) updates.
CMS recently made updates to the telehealth POS codes:
One code was revised – The POS 02 description was changed from “Telehealth or Telemedicine” to “Telehealth Provided Other than in Patient’s Home.”
One code was added – POS 10, “Telehealth Provided in Patient’s Home,” is new.
How does this affect commercial claims?
The modified POS 02 description doesn’t impact the services covered for commercial members. BCBSIL will notify you when POS 10 should be used for commercial telehealth claims, as appropriate.
Follow these guidelines for commercial telehealth claims:*
Continue using POS 02, even when telehealth is provided in a patient’s home.
Use appropriate modifiers (GT or 95) if the procedure code isn’t inherently telehealth in the description.
Don’t use POS 10 until instructed to do so. Commercial claims using POS 10 for telehealth provided in a patient’s home may be rejected.
A reminder about POS 11: As of Jan. 1, 2022, telehealth services follow standard benefits, according to details of the member’s health benefit plan. If BCBSIL receives a claim that uses POS 11, the claims will not be considered as telehealth, regardless of the procedure code, modifier and/or other claim criteria. If you submitted a telehealth claim using POS 11 for dates of service on or after Jan. 1, 2022, please resubmit/send a corrected claim.
*The instructions above apply only to claims for telehealth services provided to commercial BCBSIL members. For Medicare Advantage member claims, continue to follow CMS billing guidelines, including appropriate use of POS 02 and POS 10.
This material is for educational purposes only and is not intended to be a definitive source for coding claims. Health care providers are instructed to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit. 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, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.