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Microsoft Word - COVID-19 Blue Cross NC Coding and Billing Guidance

Blue Cross NC / Dental Blue – COVID-19 Coding and Billing Interim Guidance


Coverage / Plan Type

Would we cover limited, problem-focused evaluations performed using telecommunication technology?

Would we cover a consultation with the patients’ physician?

Will we waive frequency limits on evaluations that may be needed face-to-face later in the year, even if the following codes are used via telecommunication technology?


• D0140 – problem focused, limited evaluation

• D0170 – problem focused, re-evaluation

• D0171 – post-operative, re-evaluation

• D9311 – consultation with a medical health

care professional

• D0140 – problem focused, limited evaluation

• D0170 – problem focused, re-evaluation

• D0171 – post-operative, re-evaluation

Commercial Dental


Commercial Medical – ACA Pediatric Dental

Blue Cross NC will reimburse for D0140 and D0170 services when performed via teledentistry the same as when performed in a traditional setting. There is no additional benefit for the D9995 and D9996 codes, however these codes should be used as modifiers to document how the services were provided. However, post-operative, re-evaluation is not a covered service.

Yes

No. Our frequency limitation is 2 per benefit period to allow maximum flexibility for both member and provider. D0140, D0160, and D0170 count toward the 2 per benefit period limit regardless of the encounter type.


Other frequency limits for services such as a routine exams or phrophylaxis are also covered on a "per benefit period" basis for flexibility in scheduling for providers and patients.


Post-operative visits (D0171) are not a covered service; they are included in the fee for the original procedure.




Claims filing

QUICK TIPS:

Commercial

Dental

Include D9995/D9996 as modifiers. That is all that is needed to indicate the services were provided via teledentistry means.


Section 38: Use “11” as your provider’s office location as Place of Service.

Commercial

Medical – ACA Pediatric Dental


Section 56: Use the physical address of the treating provider’s office in the space for Address for Treating Provider’s Location.


Updated 3/31/2020