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Reimbursement Policy Update: Telemedicine Services

Horizon Blue Cross Blue Shield of New Jersey recently revised our Telemedicine Services¹ reimbursement policy to reflect recent changes including those changes pursuant to New Jersey NJ Public Law 2017, Chapter 117.

We strongly encourage you to review the guidelines of our Telemedicine Services policy.

Per the guidelines of this policy¹, real time (synchronized) telemedicine services that meet all the requirements of a face-to-face consultation or contact between a health care professional and patient are considered for reimbursement.

Telemedicine service is limited to services involving the use of interactive, real-time, two-way audio-video communication technologies for the purpose of diagnosis, consultation or treatment. Telemedicine does not include the use (in isolation) of audio-only phone conversation, email, instant messaging, phone text or fax.

The revised guidelines of this policy reflect the updates noted below.

  • CPT® codes 90785, 96160, 96161 and HCPCS codes G0296, G0506 have been added to this policy’s list of codes eligible for reimbursement.
  • HCPCS codes G0436 and G0437 have been removed from this policy’s list of codes eligible for reimbursement.
  • Modifier 95 will be recognized (in addition to Modifier GT) when appropriately appended to procedure codes that ordinarily describe face-to-face services including but not limited to, office or other outpatient professional visits, inpatient professional visits, or individual psychotherapy services.

Please note that while we continue to use Modifier 95 and Modifier GT, we have NOT adopted the use of CMS’s 02 place of service code.

CPT® is a registered mark of the American Medical Association.

¹ This reimbursement policy was formerly titled Services on a Telemedicine Platform.

² The guidelines of this policy do not apply to patients enrolled in products where Horizon BCBSNJ is secondary to Medicare (e.g., Medigap) or to patients enrolled in Horizon BCBSNJ Medicare Advantage plans.

Published on: May 21, 2018, 12:07 p.m. ET
Last updated on: October 31, 2018, 05:54 a.m. ET