BCBS FEP COVID-19 updates

The federal public health emergency ended May 11, 2023. Starting May 12, 2023, Blue Cross Blue Shield Federal Employee Program® (BCBS FEP®) began paying regular medical benefits for COVID-19-related services. Included below are member benefit changes for BCBS FEP members.

• Benefit accumulators that were paused during COVID have resumed.
• All new procedure and diagnosis codes have been evaluated and assigned benefits based on type of service.
• To initiate a claims dispute, members must submit a written request to the local plan. We no longer accept verbal requests to initiate a reconsideration.

Telehealth services provided by in-network providers (non-Teladoc providers) are covered for BCBS FEP members, until further notice.

• Effective for services incurred on or after January 1, 2022, in order for claims to process correctly and for you to receive reimbursement, you must use POS 10 or POS 02 (whichever is most appropriate).

• FEP will also cover the following telehealth-specific procedure codes when billed by participating or preferred providers: 99091, 99421-99423, 99453, 99454, 99457, 99458, 98970- 98972, 99441- 99443, 98966-98968, G0406-G0408, G0425-G0427, G2010, G2012, G2061-G2063 and Q3014.

BCBS FEP members can receive telehealth services from Teladoc.

• Benefits are currently available for minor acute conditions, behavioral health, dermatology care and nutritional counseling.
• BCBS FEP members’ telehealth benefit is specific to Teladoc and their contracted providers.
• Members are responsible for the cost share of Teladoc telehealth services.

• Covered telemedicine services are paid using standard medical benefits. Note: Excluded telemedicine services will be denied as not covered, including those billed as preventive care, with the exception of nutritional counseling visits.

Teladoc providers:

• Can prescribe 30-day medication refills for chronic conditions when medically appropriate
• Can prescribe a maximum refill of 90 days
• Continue to evaluate the clinical appropriateness, consider patient safety and the use of professional judgement when approving any refill requests

• Will perform a full consult and review the member’s medical history, if a Teladoc provider was not the initial prescriber

Members can access visit Teladoc’s website or call 1 (855) 636-1579 to receive services.

Care at skilled nursing facility or residential treatment centers

• BCBS FEP members may receive care at an out-of-network provider for medically necessary skilled nursing facility care or residential treatment centers if there is not availability at an in-network provider.

Prior approvals

• All precertification and prior approval requirements have returned to those required for pre-COVID-19 medical benefits.

Behavioral health resources

• Livongo is providing a service to help manage stressors brought on by COVID-19. The resources are a subset of Livongo’ behavioral health program, myStrength. The offering includes:
  • Strategies to manage heightened stress
  • Tips for parenting during challenging times
  • Ideas to manage social isolation
  • Other information for emotional support

• Members can register on myStrength’s COVID-19 and Mental Wellness page and send questions about the program to customerservice@mystrength.com.

Members resumed responsibility for their portion of cost share of COVID-19-related claims.

Note: All benefits are subject to the provider’s network status:

• Standard Option: Covered COVID-19 services are subject to the member’s benefits based on whether the provider is participating or non-participating.
• Basic Option and FEP Blue Focus: Covered COVID-19 services require use of a preferred provider. Some exceptions apply.

• COVID-19 testing performed in the provider’s office and treatments are now covered at regular plan cost shares.
• Over-the-counter (OTC) COVID-19 tests remain covered until further notice per an Office of Personnel Management (OPM) mandate.
• Claims using the U071 diagnosis code are subject to benefits based on the services rendered. Note: Diagnosis code U071 applies medical benefits, including applicable cost share based on the product and contracting status of the provider.

Vaccinations are covered at 100% of the plan allowance for preferred providers.

Claims submission and reimbursement

• Vaccines: During the public health emergency, the federal government will pay for the cost of the COVID-19 vaccine for all individuals. Providers need to submit claims to the federal government for the vaccine.
• Administration: We will cover the administration fees per the member's benefit. Providers should submit claims for the vaccine administration directly to their Blue Plan using the appropriate CPT code, following the same process that they do for other claims for BCBS FEP members. (Providers should include a $0.00 amount on the claim line, along with the appropriate CPT code for the vaccine.)
  • For claims processed on or before March 4, 2021: Regence used CMS' reimbursement rates in combination with our Pricing Codes without RVUs, Administrative #113, reimbursement policy for the administration.
  • For claims processed on or after March 5, 2021: Regence is processing claims for the administration based on the National Relative Units (RVUs). For claims with dates of service starting on March 15, 2021, our pricing aligns with the CMS rate increase.

• Early medication refill limits for 30-day prescription medications are no longer waived.
• Members have access to a 90-day mail order benefit for prescription medications for CVS Caremark or AllianceRx Walgreens Prime.
• Antiviral medications for COVID-19 are tiered on the formulary. The member is responsible for cost share.
• Copays are no longer waived for COVID-19-related hardship circumstances.

View all COVID-19 updates and resources.