Additional autism interventions now payable via telemedicine on an ongoing basis and restrictions are removed from protocol modification (*97155)
As previously communicated, Blue Cross Blue Shield of Michigan and Blue Care Network began allowing some services for autism spectrum disorder to be payable when delivered via telemedicine as a temporary measure during the COVID-19 pandemic.
Effective Nov. 1, 2021, we're updating our Autism Spectrum Disorder Services medical policy to allow those services to be payable via telemedicine on an ongoing basis. We're also removing restrictions on protocol modification (*97155).
These changes apply to members whose coverage includes an autism benefit.
Note: To determine which procedures can be performed via telehealth for Medicare Plus BlueSM members who have an autism benefit, see the Medicare-covered telehealth services for the COVID-19 PHE (PDF) document.
Services that are payable via telemedicine on an ongoing basis, effective Nov. 1
Per the updated medical policy, we'll allow the following autism services to be delivered via synchronous (real time) telemedicine on an ongoing (no longer temporary) basis:
Note: This service is allowed via telehealth for children who meet appropriateness criteria. The Guidelines for autism interventions delivered via telemedicine (PDF) document offers guidance in determining which members can benefit from direct-line ABA interventions delivered via telemedicine.
Restrictions lifted on protocol modification
Per the updated medical policy, protocol modification, *97155, will be allowed via real-time telemedicine visits 100% of the time. (Previously, this service was allowed to be delivered via telemedicine only 50% of the time.)
Note: During the COVID-19 pandemic for dates of service from April 14, 2020, through Oct. 31, 2021, we allowed licensed behavior analysts, or LBAs, to troubleshoot treatment protocols directly with the parent/caregiver functioning as the behavioral technician. With the Nov. 1, 2021, update to the Autism Spectrum Disorder medical policy, this temporary measure is no longer payable.
The following services continue to be payable when delivered via real-time telemedicine: caregiver training (*97156), multi-family caregiver training (*97157), supervision (S5108) and caregiver training (S5111).
Note: S5108 and S5111 are payable only to Michigan providers who deliver services to out-of-state members and cannot use the American Medical Association category 1 codes.
By Nov. 1, we'll update the following documents to reflect this change:
You can find these documents on our public website at bcbsm.com/coronavirus or within Provider Secured Services.
You can view the updated Telemedicine Services medical policy through the BCN Medical Policy Manual. To do this:
Soon, the updated policy will also be available through our Medical Policy & Pre-Cert/Pre-Auth Router on bcbsm.com.
*CPT codes, descriptions and two-digit modifiers only are copyright 2020 American Medical Association. All rights reserved.
Posted: November 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network