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.