Outpatient psychiatric centers can submit telemedicine claims to Blue Cross using their OPC NPIs

Blue Cross Blue Shield of Michigan’s commercial PPO can now accept telemedicine claims from outpatient psychiatric centers using the OPC facility NPI. This previously wasn’t possible, but we’ve revised our systems to make it easier for you to submit claims. The change was effective in April and brings the PPO commercial billing guidelines in line with those of Blue Care Network.

OPC providers no longer need to submit claims for telemedicine services using their individual professional NPI or bill under the NPI of a supervising physician for Blue Cross commercial PPO claims. As a reminder, OPCs always bill professional claims.

For telemedicine visits that include both audio and visual
Continue to bill the behavioral health procedure codes currently approved for OPC providers and append the appropriate modifiers. OPC providers should include modifiers on the claim in this order:

The modifier that indicates the licensure level (level of care) for the rendering provider (such as: AH, AJ, HO) should be listed first.

The telemedicine modifier (either GT or 95) should be listed second.

Then include place of service code 02.

For telephone-only visits (audio only)
OPC providers should include the rendering provider modifier, as appropriate, and place of service code 02.

Medicare Plus Blue^SM OPC claims should continue to be submitted using the OPC NPI. OPCs should bill for professional services rendered by practitioners for Medicare Plus Blue using the OPC NPI in the billing provider field.

For more information on telehealth
See the Telehealth for behavioral health providers guide, which is available in the telehealth sections of our coronavirus webpages. Here’s how to find these pages:

For the most up-to-date and comprehensive information, log in as a provider at bcbsm.com and click on Coronavirus (COVID-19).

If you don’t have access to Provider Secured Services, visit bcbsm.com/coronavirus (click on For Providers).

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.