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.

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.

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.