• 30-Day PASRR Waiver Update – End of Public Health Emergency (Feb. 21, 2023)
• Update – Reimbursement of Telehealth and Telephonic Health Services Post-Federal PHE (June 21, 2022)
• Timeline for the Expiration of Remaining COVID-19 Hospital Administrative Flexibilities (March 1, 2022)
• Reimbursement of COVID-19 Vaccine Counseling for All Ages (Feb. 25, 2022)
• Important Information: COVID-19 At-Home Test Claim Submission (Jan. 28, 2022)
• Reinstatement of COVID-19 Post-Acute Placement Flexibility (Aug. 13, 2021)
• Expiration of COVID-19 Policies Regarding Hospital Administrative Flexibilities (June 9, 2021)
• TennCare Extends Most Hospital Admin Flexibilities for COVID-19 to June 30, 2021; Addresses Medical Record Requests, Recoupments & Audits (March 2, 2021)
• TennCare Extends Telehealth Coverage to June 30, 2021 (Feb. 4, 2021)
• 30-Day Suspension of PASRR Requirements (Dec. 21, 2020)
• Telehealth Coverage Extended to March 31, 2021 (Dec. 16, 2020)
• CMS Targeted Payments to PCPs – with BlueCare FAQ attachment (Dec. 2, 2020)
• Extension of Hospital Admin Flexibilities for COVID-19 to March 31, 2020 (Nov. 30, 2020)
• HHS Provider Relief Fund Guidance Reporting Requirements (Oct. 5, 2020)
• Extension of Hospital Admin Flexibilities for COVID-19 (Sept. 30, 2020)
• Nursing Facilities COVID Test Payment for Medicare Enrollees (Sept. 30, 2020)
• CMS Guidance: COVID Test Payment Flow Chart Nursing Facilities (Sept. 30, 2020)
• Federal Relief Funds for Providers Deadline Extended to Sept. 13, 2020 (Sept. 4, 2020)
• Telehealth Coverage Extended to Dec. 31, 2020 (Aug. 26, 2020)
• Federal Relief Funds for Providers Deadline Extended to Aug. 28, 2020 (Aug. 7, 2020)
• CHOICES and CHOICES ECF Residential Special Needs Adjustment and Personal Care Rate Differential (July 28, 2020)
• Federal Relief Funds Deadline Extended to Aug. 3, 2020 (July 21, 2020)
• State of Emergency Extended and Telehealth Coverage Extended (July 2, 2020)
• COVID-19 DME Short-Term Guidance (June 12, 2020)
• HRSA Program FAQ Re: Provider and Facility Reimbursement for COVID-19 Testing and Treatment of Uninsured Patients (June 2020)
• Request to CMS for Targeted Payments to PCPs (June 9, 2020)
• Telehealth Coverage Extended to June 30, 2020 (June 4, 2020)
• Update on Administrative Change Flexibilities (May 8, 2020)
• Guidance and Information for Administrative Changes (April 21, 2020)
• Civil Rights Guidance (April 8, 2020)
• Federal PASRR Requirements (April 1, 2020)

Until further notice, the vaccine costs will be funded by the federal government for our medical plan members across all lines of business. However, reimbursement for administering the vaccine will vary by line of business.

TennCare will cover the cost to administer the vaccines to the following members through their Pharmacy Benefit Manager (PBM):

• BlueCare Tennessee and CoverKids members, when administered by a pharmacist.

(CoverKids folded under BlueCare effective Jan. 1, 2021, so the same provisions apply for these members.)

We’ll cover the cost to administer the vaccines to:

• BlueCare Tennessee members, including CoverKids members.
• Commercial members in most cases. Grandfathered employer self-funded health plans (those which existed before the Affordable Care Act) can make their own decisions as to what should be covered.
• Medicare Advantage and BlueCare Plus members, effective Jan. 1, 2022

Claims for vaccines funded by the federal government should not be filed with BlueCross. If you’re an immunizing provider, please file your claims as follows:

Medicare Advantage and BlueCare Plus:

• Hospitals: Submit administration claims to us according to your regular hospital contract.
• Health Departments: Submit administration claims according to your regular health department contract.
• Pharmacies: If pharmacy coverage is through BlueCross, submit claims through the BlueCross PBM.
• Other (Mobile Units, Group Practices): Submit administration claims to the CMS  Medicare Administrative Contractor’s (MAC) system.

• Hospitals: Submit administration claims to us according to your regular hospital contract.
• Health Departments: Submit administration claims according to your regular health department contract.
• Pharmacies: Submit claims to TennCare’s Pharmacy Benefit Manager (PBM).
• Other (Mobile Units, Group Practices): Submit administration claims according to your regular professional services contract.

• Hospitals: Submit administration claims to us according to your regular hospital contract.
• Health Departments: Submit administration claims according to your regular health department contract.
• Pharmacies: If pharmacy coverage is through BlueCross, submit claims through the BlueCross PBM.
• Other (Mobile Units, Group Practices): Submit administration claims according to your regular professional services contract.

Until further notice during the COVID-19 emergency, our reimbursement for vaccine administration will be consistent with the current CMS rates. Please use the following codes when submitting claims:

• Pfizer
  • 91300 (Effective Dec. 11, 2020)
  • 0001A (Effective Dec. 11, 2020)
  • 0002A (Effective Dec. 11, 2020)
  • 0003A (Effective Aug. 12, 2021)
  • 0004A (Effective Sept. 22, 2021)
  • 91305 (Effective Oct. 29, 2021)
  • 0051A (Effective Oct. 29, 2021)
  • 0052A (Effective Oct. 29, 2021)
  • 0053A (Effective Oct. 29, 2021)
  • 0054A (Effective Oct. 29, 2021)
  • 91307 (Effective Oct. 29, 2021)
  • 0071A (Effective Oct. 29, 2021)
  • 0072A (Effective Oct. 29, 2021)
  • 0073A (Effective Jan. 3, 2022)
  • 91308 (Effective Feb. 1, 2022)
  • 0081A (Effective Feb. 1, 2022) 
  • 0082A (Effective Feb. 1, 2022)
  • 0083A (Effective June 17, 2022)
  • 91312 (Effective Aug. 31, 2022)
  • 0124A (Effective Aug. 31, 2022)
  • 91315 (Effective Aug. 31, 2022)
  • 0154A (Effective Aug. 31, 2022)
  • 91317 (Effective Dec. 8, 2022)
  • 0173A (Effective Dec. 8, 2022)

• Moderna
  • 91301 (Effective Dec. 18, 2020)
  • 0011A (Effective Dec. 18, 2020)
  • 0012A (Effective Dec. 18, 2020)
  • 0013A (Effective Aug. 12, 2021)
  • 91306 (Effective Oct. 20, 2021)
  • 0064A (Effective Oct. 20, 2021)
  • 91309 (Effective March 29, 2022)
  • 0094A (Effective March 29, 2022)
  • 91313 (Effective Aug. 31, 2022)
  • 0134A (Effective Aug. 31, 2022)
  • 91314 (Effective Aug. 31, 2022)
  • 0144A (Effective Aug. 31, 2022)
  • 91316 (Effective Dec. 8, 2022)
  • 0164A (Effective Dec. 8, 2022)

• Johnson & Johnson
  • 91303 (Effective Feb. 27, 2021)
  • 0031A (Effective Feb. 27, 2021)
  • 0034A (Effective Oct. 20, 2021)

• In-Home Administration (for use with the applicable vaccine administration code above when a vaccine is given in a patient’s home)
  • M0201 (Effective June 8, 2021)

• Novavax
  • 91304 (Effective July 13, 2022)
  • 0041A (Effective July 13, 2022)
  • 0042A (Effective July 13, 2022)
  • 0044A (Effective Oct. 19, 2022)

Please note: We’re currently processing claims for the administration of the vaccines listed above. As more vaccines become approved, we’ll add their codes to this list. If you have questions about these vaccines, please refer to the CDC website.

In April 2020, the TDH began contacting all licensed physicians and pharmacists in Tennessee, including providers, pharmacies and urgent care sites on the Tennessee Immunization Information System (TennIIS) list. You can find details about the TDH’s continued recruitment efforts on their COVID-19 vaccine distribution website. This site also includes the TDH’s draft vaccination plan, currently under review with the CDC.

In addition to state efforts, the federal government has also announced requirements for providers. To receive free supplies of the COVID-19 vaccine(s), providers must sign an agreement with the CDC, agree to vaccinate individuals regardless of the type of coverage they have and not balance bill the patient. The providers also need to meet storage and record-keeping requirements.

The TDH is working to make sure there’s an equitable distribution of vaccination sites across all 95 counties, especially in rural counties and areas with high concentrations of people in vulnerable populations. Providers who wish to administer the COVID-19 vaccine may find more information online at the TDH website. 

Please continue to work with your state and local health department for the latest information on vaccine distribution and availability in your community.

We’re prepared to quickly credential and enroll all immunizing pharmacists during the COVID-19 emergency. Providers should submit a Provider Enrollment Form (PEF) using Availity and declare the need for an expedited enrollment. You can find information about enrollment on our provider website.

When filling out the PEF, please use the Notes section to provide additional information about the expedited request, including the date the practitioner will begin providing services. Once you submit your form, we also recommend you send an email to your Network Manager with the subject line “COVID-19 Request.” That way, they can help prioritize your request with our enrollment team. Please include your expected start date and the PEF number you receive from your application.

Please note, pharmacies still need to manage enrollment through the Pharmacy Benefit Manager (PBM) for each line of business.

Adults age 18 and older are eligible for the Pfizer, Moderna and Novavax vaccine. All U.S. residents age 5 and older are now eligible for the vaccine. Children age 6 months and older are eligible for the Moderna and Pfizer vaccines and adolescents between the ages of 12 and 17 are eligible for the Novavax vaccine. The FDA has also authorized COVID-19 booster shots for all adults age 18 and older. Pfizer and Moderna have released new boosters that are authorized for children ages 5 and up and 6 and up, respectively.

 For more information about booster shots and patient eligibility, review the CDC guidance here.

Your patients can check their local health department or visit VaccineFinder.org to find vaccine locations. The U.S. Department of Health and Human Services has also created a national hotline to help connect people with disabilities to information about the COVID-19 vaccine. The Disability Information and Access Line (DIAL) can help callers find vaccine locations, schedule appointments and access community services, like transportation. Your patients can reach the hotline by calling 1-888-677-1199 or emailing DIAL@n4a.org. Calls are answered Monday through Friday between 8 a.m. and 9 p.m. ET.

Several websites offer helpful information about COVID-19 vaccines, including availability and care recommendations.

For news at the state level, the TDH regularly updates information about vaccine development and plans for administration on their COVID-19 website. They also post frequent webinars to keep providers up to speed. If you want the latest news by email, you can subscribe for updates at the bottom of this page.

Likewise, the Tennessee Hospital Association (THA) website has a number of communications guides designed to help providers talk to their patients about the vaccines. This includes recorded webinars with medical experts, presentations, vaccine toolkits and more. You can access the THA materials at tha.com.

For news at the federal level, you may want to visit the CDC COVID-19 vaccination site and the FDA COVID-19 site. The Centers for Medicare & Medicaid Services (CMS) have also issued toolkits to help providers prepare for vaccination administration once the vaccines become available.

As always, we’ll continue to provide updates on this BCBSTupdates.com site as we receive new information.

Yes. Effective March 15, 2022, until the end of the federal public health emergency, we’ll cover COVID-19 vaccine counseling, even if the patient chooses not to receive the vaccine. You may receive reimbursement for vaccine counseling during preventive health visits, when providing acute care, refills or other services, or when COVID-19 vaccine counseling is the sole reason for the visit.

To receive reimbursement, please bill CPT^® code 99401 with a CR modifier to indicate a public health emergency code. The following coding criteria also apply:

• If vaccine counseling was provided at the same time as an office visit for acute care, to address diagnosed illness or for medication refills, include modifier -25 with the office visit evaluation and management code.
• Include CR and GT modifiers if provided during a telehealth visit.
• Include CR and KX modifiers if provided telephonically.
• Only one code may be billed per day.
• When counseling parents who aren’t BlueCare Tennessee or CoverKids members, you may bill the code to children’s Medicaid ID.

Please note: To qualify for reimbursement, this service must be provided by a professional with MD/DO, NP, PA or CNM credentials. If a member receives vaccine counseling from an eligible provider in a local health department, federally qualified health center or a rural health clinic, the payment will be outside the prospective payment system rate.

Since Feb. 4, 2020, we’ve covered our members’ cost-share for COVID-19 testing, related office visits and services. This includes reimbursement for multiple tests of the same patient.

Please help us identify your COVID-related claims by using the CS modifier for these types of services provided after March 18, 2020, and through the COVID-19 emergency. When billing with the CS modifier, please be sure to use the appropriate modifiers, per guidelines from the AMA, CMS, etc. This policy applies to FDA-approved tests and those currently pending FDA approval. It also applies to testing performed by providers outside of our network.

From Feb. 4, 2020, until further notice during the COVID-19 emergency, our reimbursement will be consistent with the current CMS rates for COVID-19 lab testing. This applies to FDA-approved COVID-19 tests and those currently pending FDA approval. Please use the following codes for all contracted and non-contracted labs and providers across all BlueCross BlueShield of Tennessee product lines:

• U0001 – CDC
• U0002 – Commercial Labs
• CPT^® code 87635 to be priced at the U0002 payment or the lesser of billed charges once physicians can do their own testing
• U0003 and U0004 – High-Throughput Testing (Effective April 14, 2020)
• 87426 (Effective June 25, 2020)
• 87636 (Effective Oct. 6, 2020)
• 87637 (Effective Oct. 6, 2020)
• 87811 (Effective Oct. 6, 2020)
• 0240U (Effective Oct. 6, 2020)
• 0241U (Effective Oct. 6, 2020)
• 87428 (Effective Nov. 10, 2020)
• U0005 (Effective Dec. 4, 2020)

From March 1, 2020, until further notice during the COVID-19 emergency, our reimbursement will be consistent with the current CMS rates for COVID-19 lab testing. This applies to FDA-approved COVID-19 tests and those currently pending FDA approval. Please use the following codes to ensure timely payment.

• G2023 – home/nursing home collection from an independent lab (POS 81)
• G2024 – home/nursing home collection from an independent lab (POS 81)
• C9803 – hospital outpatient

Yes. Testing guidelines for these circumstances are outlined below:

• COVID-19 testing done 72 hours before an admission/outpatient procedure will pay “in addition” to the procedural reimbursement.
• COVID-19 testing done less than 72 hours (i.e., 48 hours), but prior to the day of the admission/outpatient procedure, will pay “in addition” to the procedural reimbursement.
• COVID-19 testing done the day of the OP procedure and billed on the same claim as the OP procedure will pay “in addition” to any OP procedure. Inpatient admission will be included in the DRG charge.

Please note: The test will be covered even if the member’s admission/OP procedure is canceled due to a positive COVID-19 test.

Yes. We’ll cover our members’ swabs and test results in a drive-through setting as part of the lab payment. However, we’ll only reimburse for our members’ COVID-19 swabs and test results in drive-through testing.

*Codes included on preferred lab exclusion list for BlueCare, TennCareSelect and CoverKids.

We’ll pay for FDA-approved versions of these tests when they’re ordered by an in-network physician during in-person or telehealth appointments.

Many of the antibody tests marketed have proved to be ineffective, so we’ll only cover the ones that the FDA has cleared, approved or given emergency use authorization for. Like you, we’re deeply invested in making sure our members get safe, effective and conclusive tests, while minimizing false or misleading diagnoses.

If the above conditions are met, our reimbursement will be consistent with the current CMS rates for COVID-19 lab testing. This applies to FDA-approved COVID-19 tests and those currently pending FDA approval. Please use the following codes to ensure timely payment:

• 86328 and 86769 – Antibody Testing During Appointment
  Effective for dates of service April 10, 2020, until further notice during the COVID-19 emergency.
• 0224U – Antibody Testing During Appointment
  Effective for dates of service June 25, 2020, until further notice during the COVID-19 emergency.

Yes.  Beginning March 16, 2020, until further notice, you may use the following codes to bill for telehealth. We’ll let you know in advance if we plan to make changes.

• CPT^® codes 99441 – 99443 for audio/telephonic provider-to-member consultations for all lines of business’s PCP or specialist benefits.
• E/M codes 99201 – 99215 for virtual and audio/telephonic consults with your patients.
• E/M codes 99421 – 99423 for non-face-to-face digital online consultations.
• CPT^® codes 98970, 98971 and 98972 for online assessments and management.
• HCPCS code G2010 for remote evaluation of video and/or images.
• HCPCS code G2012 for virtual check-ins with your patients.
• CPT® codes 90791, 90792, 90832, 90834, 90837, 90847 and 90853 for behavioral health initial evaluation and therapy.
• CPT^® codes H0032 and H2019 (with or without a modifier HO) for Applied Behavior Analysis (ABA) therapy.
• In addition, here are some more recent behavioral health codes.

Click here for a full guide on BlueCare Tennessee telehealth services.

Click here to review a program description on delivering audio-only (telephonic) behavioral health services.

When billing for telehealth, applicable service codes, diagnostic codes, modifiers and units should be reported with Place of Service-02, -10 or your normal Place of Service code with a 95 modifier appended to the CPT^®/HCPCS code. This will let us know you’ve treated our member using telehealth.

The Division of TennCare posts regular updates, including recommendations on providing care for Long-Term Services and Supports (LTSS) members in home settings. Visit the site for helpful advice.

Specific outpatient PT/OT/ST CPT^® codes are included as part of the temporary expansion of telehealth services as a result of the COVID-19 emergency.

• Effective beginning March 18, 2020, until further notice
• Providers supported by this exception are licensed physical therapists, occupational therapists and speech-language pathologists.
• All services provided are medically appropriate and necessary.
• The services must take place in real time, and the patient and provider are connected via an interactive audio and video telecommunications system.
• All relevant online communications about the member’s medical care and follow-up are included in their medical record.
• Any existing visit limitations and/or prior authorization requirements continue to apply.

When billing for telehealth, applicable service codes, diagnostic codes, modifiers and units should be reported with Place of Service-02, -10 or your normal Place of Service code with a 95 modifier appended to the CPT^®/HCPCS code. This will let us know you’ve treated our member using telehealth.

Excluded from this temporary expansion of telehealth services:
Any treatment that requires specialized hands-on care or specialized equipment, such as whirlpools, etc. This includes Athletic Trainings (97169 – 97172), Modalities (97010 – 97039) and Group Therapies. Any member currently receiving group therapy should be considered for individual therapy via telehealth.

Yes. BlueCare Tennessee will continue reimbursing telehealth services (including televisual and audio-only services) after the state PHE ends, according to TennCare guidelines. For more information, please review the Update – Reimbursement of Telehealth and Telephonic Health Services Post-Federal PHE TennCare memo.

Telehealth has made it easier for members to access health care, so we’ve decided to continue to support telehealth services for our Commercial line of business for in-network providers who offer them. Until further notice, Medicare Advantage and BlueCare Plus will continue covering telehealth during the COVID-19 emergency, as we have in the past.

You should continue using the same credentialing and enrollment processes; but let us know of any constraints or delays that you have with third-party requirements, such as CMS or accreditation. We can process your application with this additional information, and make it part of your file for our Credentialing Committee to assess. The Committee may decide to approve the application for a shortened period of time and require you to re-credential earlier to ensure that pending requirements have been satisfied.

We’re adhering to the emergency directives set forth in the State of Tennessee Executive Order by the governor, available here.

BlueCare is prepared to quickly credential and enroll all initial applicants during the COVID-19 emergency. Providers should submit a PEF and declare the need for an expedited enrollment due to the current COVID-19 emergency. You can do this by checking the COVID-19 Emergency Declaration check box, which will tell us you believe the request is related to the location and/or enrollment waivers. It will also route your enrollment to the appropriate area for review.

When you submit your form, we recommend emailing your Network Manager with the subject line “COVID-19 Request,” and include the PEF number so they are aware of the request as well as the dates the practitioners need to begin providing services.

If your office or one of your practice locations will be closed for an indefinite period, we suggest you submit that information to us in a Change Form. In the Office Hours section of the Change Form, please indicate all days that each specific location will be closed. We’ll update our member-facing, online provider directory to reflect this closure until we receive an update from you.

Your practitioners, office locations and networks will continue to display in the directory as usual, with the exception of the Location & Hours section. When the office reopens, please submit a new Change Form with the correct office hours for the location.

Thank you for continuing to keep your phone lines and websites up to date with the latest information about your practice’s policies and hours or if you’re redirecting patients to other providers. We’re reminding members to check with you before any office visit.

Yes. The following coronavirus/COVID-19 diagnosis codes have been added to the medical emergency list for all lines of business:

• B97.29
• B97.21
• Z03.818
• Z20.828
• U07.1

We allowed early refills through much of 2020, but this benefit ended on Jan. 1, 2021.

Patients taking certain chronic medications may receive 90-day refills. The 90-day supply benefit established at the beginning of the COVID-19 emergency for certain prescriptions became permanent on Sept. 1, 2021, and you can view the list of eligible medications here. Controlled substances, such as opioids, and specialty drugs are excluded from this benefit.

Additionally, your patients with BlueCare Tennessee coverage may use delivery services offered through local pharmacies.

If you want to extend an existing prior authorization that’s already been approved for an elective procedure, please contact us directly and we’ll work with you to change the date of service. Otherwise, please see below for prior authorization validity periods currently in place:

• We’re working with providers to change the dates of service to the date they call in.
• There’s currently no limit on how far in the advance we’ll change the date.