Blue Cross and BCN waiving cost share for Medicare Advantage members

As announced on May 7, Blue Cross Blue Shield of Michigan and Blue Care Network are waiving cost share for their Medicare Advantage individual and fully insured group members for certain in-person and virtual services. Members won’t be liable for any copays, coinsurance or deductibles for the following network services from May 1 through Dec. 31, 2020:

• In-person primary care services, including laboratory testing processed in the office and radiology services performed in the office
• Behavioral health office visits
• Telehealth services for both medical and behavioral health

Some Medicare Advantage groups are still making decisions on this waiver, and we’ll give further guidance as soon as possible for those groups.

During the COVID-19 state of emergency, cost share for these services will also be waived for out-of-network services. Medicare Advantage organizations are required to provide the same cost sharing for the enrollee at a non-contracted facility as if the service or benefit had been furnished at a plan-contracted facility.

The waiving of member cost share will be calculated accurately on the remittance advice but may not be reflected when checking benefits in our systems.

In-person medical services

BCN Advantage^SM members: Cost share is waived for any in-person medical services provided by the member’s primary care provider.

Medicare Plus Blue^SM members: Cost share is waived for all in-person medical services billed with a rendering provider based on the designations below with the following places of service: 03, 11, 12, 13, 14, 15, 19, 22, 34, 49, 50, 71 and 72.

• Certified nurse specialist
• General practice
• Geriatric medicine
• Family nurse practitioner
• Family practice
• Internal medicine
• Obstetrics/gynecology
• Nurse practitioner
• Pediatric medicine
• Pediatric nurse practitioner
• Physician assistant

Member cost share isn’t waived for:

• Services provided by medical specialists other than the provider types listed above
• Services provided in urgent care centers
• Laboratory services ordered by a physician and sent to an outside laboratory provider (other than COVID-19 testing)
• Medicare Part B medications administered in the office
• Supplies received from the physician in the office

In-person behavioral health services

Member cost sharing is waived for Medicare Advantage members seeking behavioral health services in a physician’s office including individual therapy, psychiatric medication consultation and group therapy.

BCN Advantage members: Evaluation and management services are covered at no cost share for the following diagnoses:

• F10-F1999
• F55-F558
• F01-F09
• F20-F54
• F59-F99

Medicare Plus Blue members: Evaluation and management services are covered at no cost share when used with the following specialties:

• Psychiatry
• Clinical psychologist (billing independently)
• Addiction medicine
• Licensed clinical social worker
• Neuropsychiatry
• Adult psychiatric mental health nursing

The following are CPT codes for behavioral health in-person visits covered with no cost share for both Medicare Plus Blue and BCN Advantage members:

Evaluation and management services: *99201-*99205, *99211-*99215

Other: *90791, *90792, *90832, *90833, *90834, *90836, *90837, *90838, *90846, *90847, *90853, *96101, *96102, *96111, *90839, *90840, *90849

Telehealth services

On April 30, the Centers for Medicare & Medicaid Services further expanded the list of services covered through telehealth to allow providers to care for patients and mitigate the risk of spreading the coronavirus. Clinicians can provide these services to new or established patients.

Blue Cross and BCN are waiving cost share for telehealth services for both medical and behavioral health for their Medicare Advantage members effective March 16 through Dec. 31. Medicare Plus Blue and BCN Advantage members can receive telehealth and other communications technology-based services wherever they are located. As mentioned earlier in this article, some self-funded Medicare Advantage groups are still making decisions on this waiver but have waived cost share through at least June 30 for these telehealth services. We’ll give further guidance as soon as possible for those groups.

Refer to our Telehealth procedure codes for COVID-19 document for the list of covered telehealth services for our Medicare Advantage members as well as Blue Cross commercial and BCN commercial members.