Policy

Blue Cross Blue Shield of Massachusetts (Blue Cross*) reimburses contracted health care providers for covered, medically necessary behavioral health telehealth (telemedicine) services.
In line with Chapter 224 of the Acts of 2012, Blue Cross defines telemedicine as the use of interactive audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment. Telehealth (telemedicine) does not include the use of audio-only telephone, fax machine, or email.
Blue Cross providers must deliver telehealth (telemedicine) services via a secure and private data connection. All transactions and data communication must be in compliance with the Health Insurance Portability and Accountability Act (HIPAA). For more information on HIPAA and electronic protected health information (EPHI) compliance, please see:
hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html.

Asynchronous telecommunication
Medical information is stored and forwarded to be reviewed at a later time by a physician or health care practitioner at a distant site. The medical information is reviewed without the patient being present. Asynchronous telecommunication is also referred to as store-and-forward telehealth or non-interactive telecommunication.

Interactive audio and video telecommunication
Medical information is communicated in real-time with the use of interactive audio and video communications equipment.
The real-time communication is between the patient and a distant physician or health care specialist who is performing the service reported. The patient must be present and participating throughout the communication.

Telehealth
 Telehealth is a broader term which includes telemedicine.

General benefit information
Covered services and payment are based on the member’s benefit plan and provider Agreement. Providers and their office staff may use our online tools to verify effective dates and member copayments before providing services. Member liability may include, but is not limited to: copayments,
deductibles, and co-insurance. Members’ costs depend on member benefits.
Certain services require prior authorization or referral.

Payment information
Blue Cross reimburses health care providers based on your contracted rates and member benefits.
Claims are subject to payment edits, which Blue Cross updates regularly.
 Blue Cross reimburses
• Certain behavioral health codes when submitted with modifier GT or modifier 95 as listed in the billing information
section below
o Psychiatric diagnostic evaluation
o Psychotherapy
o Family psychotherapy
• Certain evaluation and management codes when submitted with modifier GT or modifier 95 as listed in the billing information section below

Blue Cross does not reimburse:
• Asynchronous telecommunication
• Costs associated with enabling or maintaining contracted providers’ telehealth (telemedicine) technologies
• Interprofessional telephone or internet consultations
• Online medical evaluation
• Telephone services
• Any services not defined with GT modifier or 95 modifier

General reimbursement information:
• Modifier GT and modifier 95
o Behavioral health practitioners must use modifier GT or 95 (via interactive audio and video
telecommunications systems) to differentiate a telehealth (telemedicine) encounter from an in-person
encounter with the patient.
o When reporting modifier GT or 95, the practitioner is attesting that services were rendered to a patient via an interactive audio and visual telecommunications system.
• Reimbursement
o Reimbursement for telehealth (telemedicine) services is calculated using a reduced Practice Expense (PE)
Relative Value Unit (RVU). See the CPT and HCPCS Modifiers Payment Policy for additional information.
o Behavioral health specialties are limited to codes on their fee schedules.
• Telehealth (telemedicine) services are reimbursed when the following criteria are met:
o The provider is contracted with Blue Cross Blue Shield of Massachusetts or is providing services through a
telehealth or telemedicine vendor contracted with another Blue Cross Blue Shield Plan, and meets all terms
and conditions of the applicable contracts, including credentialing and licensure.
o The provider renders care from the location listed in his or her contract with Blue Cross Blue Shield of
Massachusetts and, where contractually specified, in accordance with the requirements regarding a
professional, non-public space.

Billing information
Specific billing guidelines
• Services rendered must fall within the scope of the provider’s license. As such, Behavioral Health specialties are limited to codes on their fee schedules.
The list of codes below is included for informational purposes only. This may not be a complete list of all the codes related to this service. Whether or not a code is listed here does not guarantee coverage or reimbursement.
Code Service description Comments

Modifiers

GT Via interactive audio and video telecommunication systems
95 Synchronous telemedicine service rendered via a real-time interactive
audio and video telecommunications system

CPT and HCPCS codes

90791 Psychiatric diagnostic evaluation Reimbursable with modifiers GTor 95

90792 Psychiatric diagnostic evaluation with medical services Effective 7/1/19: Reimbursable
with modifiers GT or 95

90832 Psychotherapy, 30 minutes with patient and/or family member Reimbursable with modifiers GT
or 95

90833 Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service Reimbursable with modifiers GT or 95

90834 Psychotherapy, 45 minutes with patient and/or family member Reimbursable with modifiers GT
or 95

90836 Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service Reimbursable with modifiers GT or 95

90837 Psychotherapy, 60 minutes with patient and/or family member, consistent with the face-to-face visit
Reimbursable with modifiers GT or 95


90838 Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) Reimbursable with modifiers GT or 95

90846 Family psychotherapy (without the patient present), 50 minutes Effective 7/1/19: Reimbursable
with modifiers GT or 95

90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
Reimbursable with modifiers GT or 95

98966 Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian; 5-10 minutes of medical discussion
Not reimbursed

98967 Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian; 11-20 minutes of medical discussion
Not reimbursed

98968 Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian; 21-30 minutes of medical discussion
Not reimbursed

98969 Online assessment and management service provided by a qualified non-physician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the internet or similar electronic communications network
Not reimbursed

99201 Office or other outpatient visit for the evaluation and management of a new patient. Typically, 10 minutes are spent face to face with the patient and/or family.
Reimbursable with modifiers GT or 95

99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination;
Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of
the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
Effective 7/1/19: Reimbursable with modifiers GT or 95

99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low
complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family
Effective 7/1/19: Reimbursable
with modifiers GT or 95

99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-toface with the patient and/or family
Effective 7/1/19: Reimbursable with modifiers GT or 95


99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family

Effective 7/1/19: Reimbursable
with modifiers GT or 95

99211 Office or other outpatient visit for the evaluation and management of an established patient. Typically, 5 minutes are spent performing or supervising these services. Reimbursable with modifiers GT
or 95

99212 Office or other outpatient visit for the evaluation and management of an established patient. Typically, 10 minutes are spent face to face with patient and/or family Reimbursable with modifiers GT
or 95

99213 Office or other outpatient visit for the evaluation and management of an established patient. Typically, 15 minutes are spent face-to-face with the patient and/or family Reimbursable with modifiers GT
or 95

99214 Office or other outpatient visit for the evaluation and management of an established patient. Typically, 25 minutes are spent face-to-face with the patient and/or family Reimbursable with modifiers GT
or 95

99441 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian; 5-10 minutes of medical discussion
Not reimbursed

99442 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian; 11-20 minutes of medical discussion Not reimbursed

99443 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian; 21-30 minutes of medical discussion Not reimbursed 99444 Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian;
using the internet or similar electronic communications network Not reimbursed

G2010 Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not
originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24  hours or soonest available appointment
Not reimbursed