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 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 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.

All COVID-19 related information can be found below in the Provider COVID-19 Resources. 

BCBSNE will commit to extending the approval dates for an already approved Pre-Authorization (PA) due to the continued precautions with coronavirus through June 30, 2021.  When this is requested by the ordering provider, BCBSNE will allow an additional six months.

Please contact our team at 800-247-1103, option 2 to begin this process. 

The BCBSNE PA nurse will then update the approval and send an updated letter to the member, provider and rendering provider (if applicable).
Requests to extend the approval dates for previously approved pre-authorizations will not be accepted on or after July 1, 2021.

As a reminder, participating (PAR) providers with BCBSNE hold a contractual obligation to advise our members/your patients to use in-network providers for COVID-19 testing or treatment.  

These providers will never ask for an upfront payment from BCBSNE members.

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.  

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.