Telehealth

We assessed more than two years of data since the start of COVID-19 to inform our new policy.

The new policy will continue to cover behavioral health, primary care and outpatient office visits – services that make up more than 97% of the telehealth claims received during the last two years, including:

• Outpatient Office Visits  
• Individual, Group and Family Psychotherapy  
• Health Behavior Interventions
• Alcohol and Substance Abuse Services
• Preventive Medicine Counseling
• Medical Nutrition Therapy
• Autism Behavioral Assessments and Adaptive Behavior Treatment Guidance
• Advance Care Planning
• Tobacco Cessation Counseling
• Established Adult Preventative/Annual Wellness Exams 
• Genetic Counseling  
• Speech Therapy Evaluations
• Psych/Neuropsychic Testing
• Telephone (audio-only) Visits*

*audio only visits will be reimbursed at 75% of the in-person reimbursement rate

In consultation with health care providers, less than 3% of telehealth payments made during the last two years were identified as less effective or inappropriate to conduct virtually and will no longer be covered the same as in-person visits, for example, surgery, anesthesia, laboratory testing and radiology. Blue Cross NC will not cover the following services.

• Dialysis Services
• Physical Therapy/Occupational Therapy Evaluations
• COVID Testing Services
• Emergency Department Evaluation & Management Services
• Hospitalization Evaluation & Management Services
• Prolonged Services
• New Patient Preventive/Annual Wellness Exams

We will continue to study patterns in telehealth and will use this data to revise or update the policy in the future. 

Blue Cross NC has covered telehealth for more than 20 years, expanded its policy at the onset of the pandemic and will continue to cover telehealth to best serve our members. The new policy covers 77 more telehealth services than our pre-pandemic telehealth policy. This is a 71% increase in the number of services covered, compared to the pre-pandemic policy.

We will mail letters to a small number of commercial members who had a medical claim for a telehealth service after April 1, 2021, if the service will not be covered under our new telehealth policy. We expect to begin mailing these letters by September 23. The services that we will no longer cover under this policy are less effective or inappropriate when provided virtually.

The new policy applies to all Blue Cross NC fully insured and administrative services only (ASO) plans, including the State Health Plan.

The new telehealth policy does not apply to Blue Cross NC members receiving care from out-of-state providers, Medicare Advantage, Healthy Blue or Federal Employee Program members.

Medicare Advantage members should review their evidence of coverage. 

Healthy Blue members have certain telehealth visits covered at parity under Medicaid benefits determined by the state.

Federal Employee Program members can find details in their Service Benefit Plan Brochure.  

Our corporate reimbursement policy for telehealth can be found here.

All telehealth services must be billed through professional claims.

Blue Cross NC will continue to pay non-facility rates for telehealth services, which reimburse at higher amounts when compared to facility rates. Audio-only telehealth services will receive 75 percent of the allowed reimbursement.  

The updated Telehealth Policy applies to approved telehealth services regardless of the software or platform the local provider is using to render the services via telehealth. For details regarding telehealth vendor coverage please refer to your member benefit booklet or contact customer service for eligibility information.  

Telehealth services must be submitted on a professional claim with an appropriate modifier to distinguish between different forms of telehealth (synchronous vs asynchronous, audio vs audio/video, etc.). 

Telehealth services must be reported with place of service code 02 or 10.