New Mexico

Medicare Advantag / Amerivantage HMO
Commercial / Premera BCBS
Medicare Advantage /
Premera BCBS
Commercial / Regence Blue
Shield of Select Counties of Washington
Medicare Advantage / Regence
BlueShield of Select Counties of Washington
7/20/20
CPT Codes
99201-99215
Communication Type
Telephone call allowed – Video not required
Type of Service
Office or other outpatient visits
POS
2
Modifier
GT or 95 (CS modifier for Covid 19 related)
Additional Notes
Effective from March 17, 2020, through September 30, 2020, Amerigroup health plans will waive member cost shares for telehealth visits, including visits for annual wellness visits, mental health or substance use disorders, for our Medicare Advantage plans. For out-of-network providers, Amerigroup is waiving cost shares from March 17, 2020, through 09/30/2020 Cost sharing will be waived for members using our authorized telemedicine service, LiveHealth Online, and for telehealth received from other providers delivering virtual care through internet video and audio services.
Cost sharing for Telemedicine
Waived
Policy Termination Date
03/19/2020-09/30/2020
Policy link/ Update link
Click Here
Additional Policy PDF 
Click Here
Last Checked Date
7/20/20
7/20/20
CPT Codes
99201-99215
99441-99443
Communication Type
Video required
Telephone call allowed- Video not required
Type of Service
Office or other outpatient visits
Telephonic encounter (Virtual check- in)
POS
11
11
Modifier
95 or GT
95 or GT
Additional Notes
Cost sharing waived ” This will not apply to shared admin, FEP, BlueCard, Providence, HCA, Medicare Supplement, and self-funded plans who opt out.”
Cost sharing waived ” This will not apply to shared admin, FEP, BlueCard, Providence, HCA, Medicare Supplement, and self-funded plans who opt out.”
Cost sharing for Telemedicine
Waived
Waived
Policy Termination Date
03/06/2020-12/31/2020
03/06/2020-12/31/2020
Policy link/ Update link
Click Here
Click Here
Additional Policy PDF 
Click Here
Click Here
Last Checked Date
7/20/20
7/20/20
CPT Codes
99201-99215
99441-99443
Communication Type
Video required
Telephone call allowed- Video not required
Type of Service
Office or other outpatient visits
Telephonic encounter (Virtual check- in)
POS
11
11
Modifier
95 or GT
95 or GT
Additional Notes
Cost sharing waived ” This will not apply to shared admin, FEP, BlueCard, Providence, HCA, Medicare Supplement, and self-funded plans who opt out.”
Cost sharing waived ” This will not apply to shared admin, FEP, BlueCard, Providence, HCA, Medicare Supplement, and self-funded plans who opt out.”
Cost sharing for Telemedicine
Waived
Waived
Policy Termination Date
03/06/2020-12/31/2020
03/06/2020-12/31/2020
Policy link/ Update link
Click Here
Click Here
Additional Policy PDF 
Click Here
Click Here
Last Checked Date
7/20/20
7/20/20
7/20/20
CPT Codes
99201-99215
99201-99215
99201-99215
Communication Type
Telephone call allowed – Video not required
Telephone call allowed – Video not required
Telephone call allowed – Video not required
Type of Service
Office or other outpatient visits
Office or other outpatient visits
Office or other outpatient visits
POS
11
11
11
Modifier
95 or CS,95
95 or CS,95
95 or CS,95
Additional Notes
CS Modifier be include along with 95 for Covid 19 related treatment
CS Modifier be include along with 95 for Covid 19 related treatment
CS Modifier be include along with 95 for Covid 19 related treatment
Cost sharing for Telemedicine
Waived for Covid only
Waived for Covid only
Waived for Covid only
Policy Termination Date
12/31/2020
12/31/2020
12/31/2020
Policy link/ Update link
Click Here
Click Here
Click Here
Additional Policy PDF 
Click Here
Click Here
Click Here
Last Checked Date
7/20/20
7/20/20
7/20/20
CPT Codes
99201-99215
99201-99215
99201-99215
Communication Type
Telephone call allowed – Video not required
Telephone call allowed – Video not required
Telephone call allowed – Video not required
Type of Service
Office or other outpatient visits
Office or other outpatient visits
Office or other outpatient visits
POS
11
11
11
Modifier
95 or CS,95
95 or CS,95
95 or CS,95
Additional Notes
CS Modifier be include along with 95 for Covid 19 related treatment
CS Modifier be include along with 95 for Covid 19 related treatment
CS Modifier be include along with 95 for Covid 19 related treatment
Cost sharing for Telemedicine
Waived for Covid only
Waived for Covid only
Waived for Covid only
Policy Termination Date
12/31/2020
12/31/2020
12/31/2020
Policy link/ Update link
Click Here
Click Here
Click Here
Additional Policy PDF 
Click Here
Click Here
Click Here
Last Checked Date

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