COVID-19 Update: Telemedicine Reimbursement Policy Addenda

We strongly encourage you to review the two addenda below that outline the telemedicine services we will consider for reimbursement during the COVID-19 pandemic (in addition to those services addressed under our existing Horizon BCBSNJ Telemedicine Services reimbursement policy). Please see the addendum for other specifics.

Per the guidelines included in these addenda, Horizon BCBSNJ will consider reimbursement for the following.

TECHNOLOGIES

The following technologies may be utilized during this public health emergency:

  • Telephonic Services (Phone call with audio only)
  • Telemedicine Services (Both synchronous audio and visual required)
  • Online Patient Portal Communication (Patient initiated virtual check-in)

SERVICES

Horizon BCBSNJ Commercial and Administrative Services Only (ASO) plans:
The temporary extended telemedicine services available to patients enrolled in Horizon BCBSNJ commercial and ASO plans include: audiology/tinnitus assessments; behavioral health assessments; behavioral health counseling; behavioral health OBAT/MAT services; hearing aid checks (binaural and monaural); occupational therapy (OT) evaluations; physical therapy (PT) evaluations; self-management education services; and speech therapy (ST) services.

Horizon BCBSNJ Medicare Advantage (MA) plans:
We will follow the Centers for Medicare & Medicaid Services (CMS) guidance in regard to the temporary extended telemedicine services available to patients enrolled in Horizon BCBSNJ MA plans.

The temporary extended telemedicine services available to these patients include: audiology/tinnitus assessments; behavioral Health Assessments; Behavioral Health Counseling; Behavioral Health OBAT/MAT services; hearing aid checks (binaural and monaural); OT evaluations; PT evaluations; self-management education services; and ST services.

MA members MUST use a practitioner participating with his/her plan. These patients DO NOT have benefits for services provided by nonparticipating practitioners.

MEDICAL RECORD DOCUMENTATION
Providers must maintain a complete and accurate record of all telemedicine services performed for Horizon BCBSNJ commercial members in accordance with applicable law, rules, regulations and policies.

CODING/BILLING
Access the Telemedicine Services reimbursement policy for billing and coding information pertaining to claims for Horizon BCBSNJ commercial and ASO members. Access coding information for Horizon BCBSNJ MA plan members.

If you have questions, please call 1-800-624-1110 to speak with a Horizon BCBSNJ Physician Services representative.