Telehealth

General
Policy Number: GP-X-016

Last Updated: Jan. 26, 2024 

Telehealth

Blue Cross and Blue Shield of Nebraska’s (BCBSNE) telehealth services policy includes the following providers:

  • Medical doctors
  • Doctors of osteopathy
  • Physician assistants
  • Nurse practitioners
  • Behavioral health providers
  • Occupational, physical and speech therapists 
  • Certified diabetic educators (effective April 1, 2022)
  • Licensed medical nutritional therapists (effective April 1, 2022)
  • Advanced Practice Midwife (effective July 1, 2023)

Legislative mandate: Out-of-network telehealth services will be covered at no cost to the member if related to COVID-19 diagnostic testing through May 11, 2023. Starting May 12, 2023, standard health plan provisions will apply with cost shares as applicable.

Effective May 1, 2023, providers exclusively delivering telehealth services must live in the state of Nebraska, be a member of a credentialed Nebraska-based PHO or employed by a licensed or credentialed facility in Nebraska. Providers will also still need to meet the credentialing criteria that is available at Credentialing Information for Providers.

Telehealth Codes

Member cost shares apply as of Jan. 1, 2021. The codes below are the only applicable telehealth codes that should be billed. Additionally, the below codes are the only applicable telehealth codes that should be billed with POS 02 or POS 10*** and modifier 95. All other procedure codes are not medically appropriate to be performed via telehealth. 

Telehealth Codes

Telehealth institutional/facility claims will no longer be allowed, except as follows: 

  • Effective Nov. 1, 2020: OT/PT/ST
  • Effective Apr. 1, 2022: POS 10 is effective with BCBSNE
  • Effective Apr. 1, 2022: G0108 Diabetic Self-Management Training
  • Effective Apr. 1, 2022: Q3014 Originating Site Fee
    • Appropriate billing of Q3014:
      Facility:
      • Claim form: UB04
      • Type of bill: 12X (Medicare Part B only), 13X, 22X (Medicare Part B only), 23X, 71X, 72X, 73X, 76X and 85X
      • Revenue code: 078X 
      • Must be billed by a critical access hospital
      • Procedure code: Q3014
      Professional:
      • Claim form: HCFA 1500
      • Procedure code: Q3014
      • Place of service: 11 (must be billed by a rural health clinic)
    • Provider at the distant site who is performing the telehealth visit with the member may bill their services on a HCFA 1500 form
      • Must use an approved telehealth code with POS 02 and modifier 95
      • POS 10 is not applicable

The below will not be considered for telehealth:

  • Quick care
  • Urgent care
  • Retail clinic
  • Ambulatory Surgical Center (ASC)
  • Minute clinic
  • Pharmacy

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.

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.

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