New Jersey
Medicare Advantage / Amerivantage HMO
Medicare Advantage / Horizon BCBS
Medicare Advantage / Wellcare HMO
Commercial / Horizon BCBS Commercial
Medicare Advantage / Amerivantage HMO
| Last Checked Date | 7/27/2020 |
|---|---|
| CPT Codes | 99201-99215 |
| Communication Type | Telephone Call Allowed- Video Not Required |
| Type of Service | Office or other outpatient visits |
| POS | 2 |
| Modifier | 95 |
| Additional Notes | |
| Cost sharing for Telemedicine | Waived |
| Policy Termination Date | Not available |
| Policy Link/Update Link | Click Here |
| Additional Policy PDF |
Medicare Advantage / Horizon BCBS
| Last Checked Date | 7/15/20 | 7/15/20 | 7/15/20 |
|---|---|---|---|
| CPT Codes | 99201-99215 | 99441-99443 | G2012 |
| Communication Type | Video required | Telephone call allowed- Video not required | Telephone call allowed- Video not required |
| Type of Service | Office or other outpatient visits | Telephonic encounter (Virtual check-in) | Telephonic encounter (Virtual check- in) |
| POS | 2 | 2 | 2 |
| Modifier | GT or 95 ( Add CS modifier if member cost share was not collected ) | Blank ( Add CS modifier if member cost share was not collected ) | Blank ( Add CS modifier if member cost share was not collected ) |
| Additional Notes | Beginning with dates of service on and after July 15, 2020, this cost-share waiver is only in effect for services when the primary diagnosis is COVID-19. Specifically: Outpatient claims will not have member cost sharing if the primary diagnosis is U07.1, Z03.818 or Z20.828. This change applies to fully insured members including those covered by Medicare Advantage, and Individual and Small Group policies. Self-insured health plans are responsible for the specific plan designs they choose to offer to their employees, and Horizon BCBSNJ will continue to work with them to administer their plan designs as directed. | Beginning with dates of service on and after July 15, 2020, this cost-share waiver is only in effect for services when the primary diagnosis is COVID-19. Specifically: Outpatient claims will not have member cost sharing if the primary diagnosis is U07.1, Z03.818 or Z20.828. This change applies to fully insured members including those covered by Medicare Advantage, and Individual and Small Group policies. Self-insured health plans are responsible for the specific plan designs they choose to offer to their employees, and Horizon BCBSNJ will continue to work with them to administer their plan designs as directed. | Beginning with dates of service on and after July 15, 2020, this cost-share waiver is only in effect for services when the primary diagnosis is COVID-19. Specifically: Outpatient claims will not have member cost sharing if the primary diagnosis is U07.1, Z03.818 or Z20.828. This change applies to fully insured members including those covered by Medicare Advantage, and Individual and Small Group policies. Self-insured health plans are responsible for the specific plan designs they choose to offer to their employees, and Horizon BCBSNJ will continue to work with them to administer their plan designs as directed. |
| Cost sharing for Telemedicine | Waived for Covid only | Waived for Covid only | Waived for Covid only |
| Policy Termination Date | 03/01/2020-Until further update | 03/01/2020-Until further update | 03/01/2020-Until further update |
| Policy Link/Update Link | Click Here | Click Here | Click Here |
| Additional Policy PDF | Click Here | Click Here | Click Here |
Medicare Advantage / Wellcare HMO
| Last Checked Date | 7/20/20 | 7/20/20 |
|---|---|---|
| CPT Codes | 99201-99215 | 99441-99443 |
| Communication Type | Video required | Telephone call allowed- Video not required |
| Type of Service | Office or other outpatient visits | Telephonic encounter (Virtual check-in) |
| POS | 11 | 11 |
| Modifier | 95 | Blank |
| Additional Notes | Waiving in-network member costs for all primary care visits for the rest of 2020. We are also waiving member costs for outpatient, non-facility-based behavioral health visits and are extending telehealth cost share waivers for all telehealth visits-primary care, specialty, and behavioral health-for in-network providers for the remainder of 2020. This does not include inpatient hospital, behavioral health facility, or urgent care visits. Medicare members with state benefits will continue to receive support through coordination with their states. | Waiving in-network member costs for all primary care visits for the rest of 2020. We are also waiving member costs for outpatient, non-facility-based behavioral health visits and are extending telehealth cost share waivers for all telehealth visits-primary care, specialty, and behavioral health-for in-network providers for the remainder of 2020. This does not include inpatient hospital, behavioral health facility, or urgent care visits. Medicare members with state benefits will continue to receive support through coordination with their states. |
| Cost sharing for Telemedicine | Waived | Waived |
| Policy Termination Date | Not available | Not available |
| Policy Link/Update Link | Click Here Click Here |
Click Here Click Here |
| Additional Policy PDF | Click Here | Click Here |
Commercial / Horizon BCBS Commercial
| Last Checked Date | 7/15/2020 | 7/15/2020 | 7/15/2020 | 7/15/2020 |
|---|---|---|---|---|
| CPT Codes | 99201-99215 | 99241-99245 | 99441-99443 | G2012 |
| Communication Type | Video required | Video required | Telephone call allowed- Video not required | Telephone call allowed- Video not required |
| Type of Service | Office or other outpatient visits | Office or other outpatient visits | Telephonic encounter (Virtual check-in) | Telephonic encounter (Virtual check-in) |
| POS | 11 or 2 | 11 or 2 | 11 | 11 |
| Modifier | GT or 95 ( Add CS modifier if member cost share was not collected ) | GT or 95 ( Add CS modifier if member cost share was not collected ) | Blank ( Add CS modifier if member cost share was not collected ) | Blank ( Add CS modifier if member cost share was not collected ) |
| Additional Notes | Beginning with dates of service on and after July 15, 2020, this cost-share waiver is only in effect for services when the primary diagnosis is COVID-19. Specifically: Outpatient claims will not have member cost sharing if the primary diagnosis is U07.1, Z03.818 or Z20.828. This change applies to fully insured members including those covered by Medicare Advantage, and Individual and Small Group policies. Self-insured health plans are responsible for the specific plan designs they choose to offer to their employees, and Horizon BCBSNJ will continue to work with them to administer their plan designs as directed. | Beginning with dates of service on and after July 15, 2020, this cost-share waiver is only in effect for services when the primary diagnosis is COVID-19. Specifically: Outpatient claims will not have member cost sharing if the primary diagnosis is U07.1, Z03.818 or Z20.828. This change applies to fully insured members including those covered by Medicare Advantage, and Individual and Small Group policies. Self-insured health plans are responsible for the specific plan designs they choose to offer to their employees, and Horizon BCBSNJ will continue to work with them to administer their plan designs as directed. | Beginning with dates of service on and after July 15, 2020, this cost-share waiver is only in effect for services when the primary diagnosis is COVID-19. Specifically: Outpatient claims will not have member cost sharing if the primary diagnosis is U07.1, Z03.818 or Z20.828. This change applies to fully insured members including those covered by Medicare Advantage, and Individual and Small Group policies. Self-insured health plans are responsible for the specific plan designs they choose to offer to their employees, and Horizon BCBSNJ will continue to work with them to administer their plan designs as directed. | Beginning with dates of service on and after July 15, 2020, this cost-share waiver is only in effect for services when the primary diagnosis is COVID-19. Specifically: Outpatient claims will not have member cost sharing if the primary diagnosis is U07.1, Z03.818 or Z20.828. This change applies to fully insured members including those covered by Medicare Advantage, and Individual and Small Group policies. Self-insured health plans are responsible for the specific plan designs they choose to offer to their employees, and Horizon BCBSNJ will continue to work with them to administer their plan designs as directed. |
| Cost sharing for Telemedicine | Waived for Covid only | Waived for Covid only | Waived for Covid only | Waived for Covid only |
| Policy Termination Date | 03/01/2020-Until further update | 03/01/2020-Until further update | 03/01/2020-Until further update | 03/01/2020-Until further update |
| Policy Link/Update Link | Click Here | Click Here | Click Here | Click Here |
| Additional Policy PDF | Click Here | Click Here | Click Here | Click Here |
State Telemedicine Policy
