Additional autism interventions delivered through telemedicine now payable

As previously communicated, Blue Cross Blue Shield of Michigan and Blue Care Network began allowing some services for autism spectrum disorder to be payable when delivered through telemedicine as a temporary measure during the COVID-19 pandemic.

Effective Nov. 1, 2021, we’re updating our Autism Spectrum Disorder Services medical policy to allow those telemedicine services to be payable on an ongoing basis. We’re also removing restrictions on protocol modification *97155.

These changes apply to members whose coverage includes an autism benefit. 

To determine which procedures can be performed through telemedicine for Medicare Plus Blue℠ members who have an autism benefit, see the Medicare-covered telehealth services for the COVID-19 PHE document.

Telemedicine services payable on an ongoing basis, effective Nov. 1

Per the updated medical policy, we’ll allow the following autism services to be delivered through synchronous (real time) telemedicine on an ongoing (no longer temporary) basis:

• Assessment, *97151
• Applied behavior analysis, or ABA, *97153

This service is allowed for children who meet appropriateness criteria. The Guidelines for autism interventions delivered through telemedicine document offers guidance in determining which members can benefit from direct-line ABA interventions delivered through telemedicine.

• Skills training, *97154
• Intensive skills training, *97158

Restrictions lifted on protocol modification

Per the updated medical policy, protocol modification *97155, will be allowed through real-time telemedicine visits 100% of the time. (Previously, this service was allowed to be delivered through telemedicine only 50% of the time.)

During the COVID-19 pandemic, for dates of service from April 14, 2020, through Oct. 31, 2021, we allowed licensed behavior analysts, or LBAs, to troubleshoot treatment protocols directly with the parent or caregiver functioning as the behavioral technician. With the Nov. 1, 2021, update to the Autism Spectrum Disorder medical policy, this temporary measure is no longer payable.

Reminder

The following services continue to be payable when delivered through real-time telemedicine: caregiver training (*97156), multi-family caregiver training (*97157), supervision (S5108) and caregiver training (S5111).

S5108 and S5111 are payable only to Michigan providers who deliver services to out-of-state members and can’t use the American Medical Association category 1 codes.

Updated documents

We’ve updated the following documents to reflect this change:

• Telehealth for behavioral health providers
• Temporary changes due to the COVID-19 pandemic

You can find these documents on our public website at bcbsm.com/coronavirus or within Provider Secured Services.

You can view the updated Telemedicine Services medical policy through our Medical Policy & Pre-Cert/Pre-Auth Router on bcbsm.com.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.