Effective Sept. 1, 2020

Fully Insured Members

Wellmark has and will continue to provide benefits for telehealth (or virtual) visits for fully insured members. The $0 member cost-share for virtual visits will expire on Aug. 31 for fully insured members. This has been offered since the start of the pandemic to help the health care systems in Iowa and South Dakota by minimizing in-person visits to ERs or clinics as they prepared to potentially care for COVID-19 patients. After Aug. 31, a fully insured member will need to pay their standard cost-share for that benefit, which is no more for telehealth than an in-person visit.

Self-Funded Members

Some employers are self-funded, which means they make the decisions as to what benefits are offered on their plan. A few self-funded employer group plans do not provide coverage for or have limited telehealth benefits. Now that the health care systems have adapted and are able to serve more patients in-office, some of these self-funded plans are returning to our standard telehealth benefits. After Aug. 31, providers are encouraged to log into the Provider portal to check members' benefits prior to delivering telehealth services.

Telehealth Payment Parity - Updated Jan. 5, 2021

Wellmark will extend payment parity for appropriate medical and behavioral health virtual visits with an in-network provider in Iowa until June 30, 2021, and in South Dakota until further notice.

While Wellmark’s preference is that providers conduct virtual visits via interactive audio-visual technology, we recognize that some of our members may not have a smart phone, tablet, or personal computer capable of engaging in an interactive audio-video visit. As such, Wellmark will allow telephonic visits through this period, when audio-visual capabilities aren’t accessible. For claims to process accurately, providers must follow these billing guidelines:

• Providers should bill the appropriate CPT codes for the services provided (see list below).
• Use place of service 02 (telehealth) on the claim for interactive audio-video or telephonic visits.
• Do NOT use a GT or 95 modifier or the claim will deny.
• Providers conducting telephonic only visits with Wellmark’s members during this period must document in their medical records that the visit was conducted via telephone.
• Benefit information on coverage of virtual visits for Wellmark’s members will not be updated on the Claims and Benefits Look-up tool on wellmark.com during this period.

Providers must continue to check benefits for other Blue Cross Blue Shield members as their coverage of virtual visits may vary.

Mar. 16, 2020 - Aug. 31, 2020

Wellmark has received many questions from providers regarding coverage of telehealth services amid the coronavirus (COVID-19) pandemic. As Iowa and South Dakota grapple with the COVID-19 pandemic, we know that virtual visits will play a vital role in preserving access to care and preventing the spread of the novel coronavirus.

Wellmark is taking these steps to increase access to virtual visits for all of our members during this time:

1. Wellmark’s Iowa and South Dakota network providers will receive the same fee for virtual visits as an in-person visit. These changes apply to all appropriate medical and behavioral health virtual visits with any Wellmark in-network provider until Aug. 31, 2020. Wellmark will reevaluate this date as the pandemic situation evolves.
2. Wellmark has made virtual visits available without any member cost-share for fully-insured members to remove barriers to receiving care. In addition some self-funded clients have chosen to match Wellmark for their members. Effective June 17, other self-funded groups have elected to follow their current benefit structures (group numbers listed below): 

   Group Number
   XA001
   56794

While Wellmark’s preference is that providers conduct virtual visits via interactive audio-visual technology, we recognize that some of our members may not have a smart phone, tablet, or personal computer capable of engaging in an interactive audio-video visit. As such, Wellmark will allow telephonic visits through this period, when audio-visual capabilities aren’t accessible. For claims to process accurately, providers must follow these billing guidelines:

• Providers should bill the appropriate CPT codes for the services provided (see list below).
• Use place of service 02 (telehealth) on the claim for interactive audio-video or telephonic visits.
• Do NOT use a GT or 95 modifier or the claim will deny.
• Providers conducting telephonic only visits with Wellmark’s members during this period must document in their medical records that the visit was conducted via telephone.
• Benefit information on coverage of virtual visits for Wellmark’s members will not be updated on the Claims and Benefits Look-up tool on wellmark.com during this period.

Providers must continue to check benefits for other Blue Cross Blue Shield members as their coverage of virtual visits may vary.

Medically Appropriate codes for virtual visits

Based on input from physicians and other clinicians in our two states, Wellmark has established the following list of services that can be performed via a virtual visit (telehealth) and will be paid at the in-office fee from March 16 through Aug. 31:

Medical or Office Visits

Behavioral Health Services

Therapeutic Services

Other codes will be evaluated if the need arises.