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 don't hesitate to reach out with questions or issues.

COVID-19 Updates to Support our Providers 

Updated May 11, 2021

Does BCBSNE cover all diagnostic antigen or antibody testing that includes a component for diagnosing COVID-19?
BCBSNE covers medically appropriate COVID-19 testing to diagnose coronavirus when ordered by a physician or health care professionals. Cost shares will be waived during the public health emergency. Tests must be FDA approved and administered in accordance with federal agency specifications.    

It is appropriate to test a person who shows symptoms and/or has suspected exposure to a person or persons with coronavirus.   

Effective Nov. 1, 2020, BCBSNE began excluding COVID-19 testing for surveillance purposes, as it is not medically appropriate; the CARES Act does not require these types of tests to be covered by plans and issuers. This includes tests done for public surveillance, return to work, school, travel, etc.

Multiple tests for COVID-19 antigens in the same day are not medically necessary. The rapid test or PCR tests are both reliable on their own. A person does not need to have both tests done to determine if they have COVID-19. Based on the time of the exposure and/or symptoms presented at the time of testing, the ordering health care provider should administer the most appropriate test.

Medically appropriate tests to diagnosis COVID-19 include:

  • COVID-19 only
    • COVID-19 Test: U0001, U0002, U0003, U0004, 87635, 87426, 87811
  • COVID-19 and Influenza
    • COVID-19 Test: 87428, 87636
  • COVID-19, Influenza and Upper Respiratory
    • COVID-19 Test: 87637

Large panel tests outside of the PCR and rapid tests are unnecessary and not appropriate for the testing of COVID-19. In accordance with CDC guidance, providers should perform the most appropriate test needed based on symptoms presented by an individual. In most cases, a single component COIVD-19 test would be the most appropriate for diagnostic purposes.

  • Example: 87633, 0202U, 0223U, 0225U are not appropriate testing. 
  • These types of panel tests would be appropriate in a setting of multiple negative tests with a symptomatic patient. They should not be used as a screening tool.
  • Large panel tests will be denied as not medically appropriate. 

Proprietary Laboratory Analysis (PLA) tests are tests where only designated providers (laboratories and manufacturers) can perform the test. It is not appropriate for unauthorized providers to perform these types of tests. 

  • Example: 0202U, 0240U, 0241U, 0223U, 0224U, 0225U, 0226U.
  • PLA tests done by unauthorized providers will be denied. 

Antibody tests do not diagnose a person who currently has coronavirus. This test provides results to let a person know if they have had coronavirus at some point. It is only appropriate to run a COVID-19 antibody test if the individual is planning on donating blood/plasma, or a physician feels it may alter the way they are treating a patient.

COVID-19 extensions are being extended through September 30, 2022.  Please be advised of the following: 

  1. Temporarily suspending the requirement for a NE license if they are in good standing and free from disciplinary action in the state(s) where they are licensed. This includes those who are properly and lawfully licensed to perform:
    1. Advanced practice nursing
    2. Emergency medical services
    3. Medicine and surgery
    4. Mental health practice
    5. Nursing
    6. Osteopathy
    7. Perfusion
    8. Pharmacy
    9. Psychology
    10. Respiratory care
    11. Surgical assisting 
    12. Alcohol and drug counseling
    13. Audiology
    14. Speech-language pathology
    15. Medical nutrition therapy
    16. Medical radiography
    17. Nursing home administration
    18. Occupational therapy
    19. Physical therapy 
  2. Providers with inactive or expired licenses formerly licensed in the state of NE who want to renew a credential after its expiration date or go from an inactive to active status will not be subject to continuing competency requirements. 
  3. Temporarily suspend requirements for issuing licenses for physicians, nurses, and pharmacy related professions to be processed electronically prior to receipt of license fee, pending test scores, pending national criminal history (pending provider licenses)

For additional information please visit Administrative Updates. 

Blue Cross and Blue Shield of Nebraska will be reinstating precertification’s and prior authorization’s beginning March 15, 2022.

Please be sure to use the preauthorization tool via NaviNet.  If you have questions, please contact our nurse care manager team at 844-201-9644.

As we continue to support our healthcare providers throughout the state, BCBSNE has made the decision to allow Remdesivir in the OP setting without a prior authorization, effective December 23, 2021.

  • Claims with procedure codes not medically appropriate to be performed via telehealth will begin denying.
  • Today, these claims are being returned with an Action Needed letter to please resubmit for proper billing. 
  • Please refer to the General Policy and Procedure manual page 61 for a listing of medically appropriate telehealth codes.

Effective immediately, BCBSNE will require preauthorization and will review its use with guidance from the medical policy. Due to lack of evidence and support from multiple national health associations, ivermectin’s use for COVID-19 treatment and prevention outside of a clinical trial is considered investigational. This applies to all commercial BCBSNE fully insured, self-funded, and individual plan members.

2 Easy Options

We have provided 2 easy options for our providers to request use of ivermectin.

  1. Use our online Medical Policy Tool available online at: Medical Policy Tool. We have enabled functionality for auto-determinations for some cases when this tool is used. Using other online programs and tools that are not operated by BCBSNE we are not able to adjust those programs for this use.
  2. Use the General Medication Preauthorization Physician Fax Form and fax to the number provided at the bottom of the form.

The Modifier-CS represents Cost Share Waiver for COVID-19. This requires insurers and health plans to waive the cost-share (deductible, coinsurance and/or copay) for individual for certain COVID-19 testing and the related services to the testing.  
The CS Modifier should only be used on COVID-19 testing-related services, which are medical visits that:

  1. Are between March 18, 2020 through the end of the Public Health Emergency; 
  2. Result in an order for or administration of a COVID-19 test; 
  3. Are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test; AND
  4. Are included in the following categories of HCPCS evaluation and management codes:
    • Office and other outpatient services
    • Hospital observation services
    • Emergency department services
    • Nursing facility services
    • Domiciliary, rest home or custodial care services
    • Home services
    • Online digital evaluation and management services

The CS modifier should only be placed on the evaluation and management codes and testing done to diagnose COVID-19. It should not be used on codes tied to other services to treat or prevent COVID-19.

COVID-19 vaccine administration claims processed prior to March 9, 2021 may have applied member cost share in error.  These claims are being reviewed for adjustments; nothing is needed from the provider. 

Please do not submit reconsiderations on these claims, this could delay or contribute to further processing issues.

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.