COVID-19

As we continue to evaluate the information around the coronavirus pandemic, we want to make sure you have pertinent information available that impacts you and our members. Please know we extend our wishes for health and safety during these trying times; don't hesitate to reach out with questions or issues.

Furthermore, due to the ever-changing status of COVID-19, BCBSNE will research and make retroactive changes to claims on your behalf as we adjust our policies.

COVID-19 Updates to Support our Providers

Effective July 1, 2020, BCBSNE will update its policy to waive member cost-share for telehealth services to a limited number of providers, including:

  • Medical doctors
  • Doctors of osteopathy
  • Physician assistants
  • Nurse practitioners
  • Behavioral health providers

BCBSNE will continue to pay eligible providers at regular fee schedule levels and will require providers to use video and a HIPPA-secure platform to receive full payment.  

Telehealth Codes

Additionally, the cost-share waiver will continue to apply to a limited number of codes, including:

90785  90955 96156 99201-99204 G0270
90791 90957 96159-96161 99211-99214 G0296
90792 90958 96164 99231-99233 G0396-G0397
90832-90840 90960 96165 99307-99310 G0406-G0408
90845-90847 90961 96169 99354-99355 G0436-G0437
90951 90963-90970 96168 99406-99407 G0442-G0447
90954 96116 97802-97804 90785 G2086-G2088
93107 99451      

Continue to use place of service 02 and modifier 95 with the appropriate CPT codes. 

These changes are specific to BCBSNE members; please check benefits for Federal Employee Program (FEP) or out-of-state Blue Cross and Blue Shield members. For coverage information on other Blue Cross and Blue Shield (BCBS) Plans, as well as the BCBS FEP, related to COVID-19 treatment go to   bcbs.com.

For Medicare Advantage members, we will continue to cover telehealth services for non-COVID-19 related services after July 1 for the remainder of the year, however, the applicable cost-shares/copays will apply.  

BCBSNE will allow facility claims submitted on a UB for Telehealth. Please use modifier 95 to identify such claims. 

Providers performing and billing teleservices must be eligible to independently perform and bill the equivalent face-to-face service. 

Our members may seek telehealth services through their current physician/provider, or they can receive services through Amwell®. This information has been communicated separately to our members.

As we continue to partner with you, we want to thank you for the care you provide our members, especially in times of crisis.




Amwell® is an independent company that provides telehealth services for Blue Cross and Blue Shield of Nebraska.

BCBSNE continues to support its customers and has made the decision to extend its member cost-share waiver for in-network treatment of COVID-19 through Sept. 30, 2020. The cost-share waiver applies to office, urgent care, emergency room and inpatient hospital stays for COVID-19 treatment for the following BCBSNE plan members: 

  • Fully-insured
  • Individual
  • Medicare Supplement
  • Medicare Advantage

Further supporting our providers, 100% of allowable amounts for in-network covered benefits will be paid.

In addition to BCBSNE, other Blue Cross and Blue Shield (BCBS) Plans, as well as the BCBS Federal Employee Program (FEP), are waiving member cost shares related to COVID-19 treatment. For more information, go to  bcbs.com.

Effective June 1, 2020, BCBSNE  is extending its cost-share waiver to Sept. 30, 2020 for medications used to treat COVID-19.  

At this time, the evaluation of Actemra for the treatment of COVID-19 will also be considered. BCBSNE will follow already-established processes for its use given it is also included in Medical Policy X.42. A cost-share waiver may be granted if Actemra is used for COVID-19 treatment. This applies to BCBSNE fully insured, individual plan members and some self-funded employers.

In addition to BCBSNE, other Blue Cross and Blue Shield (BCBS) Plans, as well as the BCBS Federal Employee Program (FEP), are waiving member cost shares related to COVID-19 treatment. For more information, go to   bcbs.com.

Diagnostic testing for SARS-CoV-2 (COVID-19) is considered medically necessary when done for the diagnosis and treatment of coronavirus infection.  Routine antibody testing in asymptomatic patients for public health purposes, such as return to work scenarios, are not considered medically necessary.  Antibody testing for COVID-19 may be medically necessary when performed to guide the treatment of an individual patient, when the test is FDA approved or FDA authorized, including EUA authorized testing, and when the test is ordered by a licensed health care provider.

BCBSNE has sent notification to UR and CM teams ensuring everyone is aware we will begin reinstatement of our precertification requirements.

Currently we are all working towards the goal of a new normal and part of that is to re-establish our precertification process. We will reinstate our precertification requirements for inpatient admissions beginning July 1, 2020.

Thank you for all you do for our members each day. We appreciate your dedication and service. Please continue to watch our COVID-19 page for updates.

Effective April 15:
  • BCBSNE will continue to cover brand ProAir HFA, ProAir Respiclick and Ventolin HFA as preferred albuterol inhalers.
  • BCBSNE will expand temporary coverage of generic ProAir HFA (labeled as albuterol HFA), generic Proventil HFA (upon release), Proventil HFA and the authorized generics of Proventil HFA and Ventolin HFA (labeled as albuterol HFA).

BCBSNE has implemented this change due to shortages of albuterol at some pharmacies. BCBSNE is supporting our network pharmacies by allowing them to use available stock to meet the needs of our members.

Please note: This change is temporary. These coverage updates will be in place through June 30, 2020. This shortage will be evaluated prior to June 30, 2020 to determine if continuation is warranted.

BCBS Federal Employee Program (FEP) understands there are times when it is necessary and appropriate for our non-teladoc network providers to also treat patients remotely. With this in mind, we will allow for appropriate covered services (i.e., office visits with primary care, specialty and mental health providers, ABA, speech and other therapies) when billed with the correct place of service (02) and modifier (95 GT and GQ).

In these cases, non-telehealth benefits will apply, meaning regular office visit copays will be charged to the member for the remote virtual visit depending on which option they are enrolled in, whether the provider is a PCP and SCP and what the provider’s contracted status is.  

However, if the claim is related to testing or treatment for COVID-19, member cost-share is waived regardless of the provider’s contracted status. 

Note: Cost-share is waived regardless of whether the COVID-19 test comes back positive or negative. 

For services provided under the telehealth benefit by a teladoc provider, member cost-share is being waived. For services from non-teladoc providers, member cost-share is only being waived if those services are for testing or treatment of COVID-19. Telehealth charges are accepted from any credentialed provider with no video component required during this pandemic urgency period.

A provider may bill using E&M codes, therapy codes or telehealth codes and must use the modifier 95, GT and GQ and POS 02 for reimbursement. Normal cost-shares will apply; however, if the claim is related to testing or treatment for COVID-19, member cost-share is waived regardless of the provider's contracted status.

Notice of termination for this policy will be given in writing at least 60 days prior to termination.  However, we will review and consider an extension for this policy as needed.    

Telehealth Codes

Please use in place of service 02 and modifier 95, GT and GQ with the appropriate CPT codes. We have updated the fee schedule to reflect these changes. To download the fee schedule,  log in to NaviNet.

Our members may seek telehealth services through their current provider, or they can receive services through teledoc. This information has been communicated separately to our members.

Thank you for the care you provide our members, especially in times of crisis.  

Effective April 9, 2020, BCBSNE is extending the timely filing deadline for providers to Dec. 31, 2020 or to providers’ current contract filing deadline, whichever is later.

BCBSNE will cover the following teledentistry billing codes for in-network care through June 30:
  • D0140 – Limited oral examination – problem focused
  • D0170 – Re-evaluation – limited, problem focused
  • D0171 – Re-evaluation – post-operative office visit  
  • D0190 – Screening of a patient
  • D9992 – Dental case management – care coordination
  • D9995 – Teledentistry – synchronous; real-time encounter (identifier only)
  • D9996 – Teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review (identifier only)

Effective immediately, BCBSNE will implement a quantity-limit program for hydroxychloroquine and chloroquine products to preserve supplies and enable currently established patients to continue treatment while allowing flexibility for members that may be prescribed this treatment for an active COVID-19 infection.

Details:
  • The quantity-limit program will limit use to one course of therapy every three months.
  • Prescriber can demonstrate the need for higher doses or another course of therapy for COVID-19 to go beyond the quantity limit by using our online  Medical Policy Tool or by using our  General Medication Preauthorization Physician Fax Form
  • For those newly starting therapy for a non-COVID-19 indication, quantity-limit review will be required to go beyond the established quantity limits.
  • Members with paid claims prior to the COVID-19 outbreak are assumed to be using for a non-COVID-19 indication and will be grandfathered in to eliminate the need to submit a clinical review.

This will help support efforts to maintain adequate supply in the market while effectively treating our members that need it.

To obtain auto-approval please use our  MedPolicy Blue tool

BCBSNE has made the following adjustments in response to Gov. Ricketts’ announcement allowing retired and out-of-state providers to practice in Nebraska during the pandemic:

BCBSNE will review credentialing criteria on a case-by-case basis and evaluate whether providers meet the criteria to be allowed in network and recredentialed later.

BCBSNE will loosen the following criteria:
  • License requirements 
  • FBI background checks
  • Test dates and results due to boards being postponed

We recommend retired and out-of-state providers submit using the Locum Tenens billing guidelines found in the  General Policies and Procedures. This will eliminate the need to have these providers in the directory and uploaded into the system. Additionally, it will ensure providers are paid according to their specialty and networks.