Name of Manual - Blue Cross and Blue Shield of Minnesota

Prolonged Physician
Services
Coding Policies and Guidelines (Medical Services)
Blue Cross reimburses face-to-face prolonged physician services
codes 99354-99357. Codes 99358-99359 are not reimbursed
(prolonged services without face-to-face patient contact) and will
deny as provider liability.
Telephone Calls Telephone calls, codes 99441-99443 and 98966-98968, are noncovered
services. Calls are considered an integral part of other
services the patient receives (usually an evaluation and
management service) and not separately reimbursable.
Medical Team
Conferences
Televideo
Consultations
Medical conferences without face-to-face patient contact, codes
99367-99368, are not reimbursed, and will deny as provider
liability.
Blue Cross provides reimbursement for certain televideo
consultations. These consultations are also sometimes referred to
as telemedicine or telehealth services. Televideo consultations are
interactive audio and video communications, permitting real-time
communication between a distant site physician or practitioner and
the member, who is present and participating in the televideo visit
at a remote facility.
Coverage of televideo consultations includes consultations, office
visits, psychotherapy, substance use disorders, as well as the codes
allowed per Medicare policy. Facilities may be reimbursed for the
origination fee. Both the consulting physician and the remote clinic
or remote site will submit a claim for their services. The consulting
physician will bill the appropriate CPT evaluation and
management, psychotherapy code, nutrition therapy or follow-up
telehealth consult code. The remote provider will bill for the
originating site facility fee only. This service is billable on either
the professional or institutional claim format.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/20/12)
11-43