Provider News & Updates

Below you will find the latest on important information that may impact your practice, as well as copies of letters and notices we have released.

News and Updates

May 23, 2023


Radiotracer services require prior approval starting August 1, 2023. Review full details here.

May 18, 2023

NEHP/ABNE Radiology Prior Approval moving to Carelon

Effective immediately, Carelon will be doing the radiology prior approval for New England Health Plan and Access Blue New England members. Review full details here.

May 17, 2023

Lifestyle Medicine Certification Opportunity

Blue Cross and Blue Shield of Vermont, in partnership with the American College of Lifestyle Medicine (ACLM) and the American Board of Lifestyle Medicine (ABLM), is offering Lifestyle Medicine training and board certification to our clinical provider network through a unique scholarship program. 

We are funding 50 awards to cover the cost of certification to eligible healthcare clinicians who are interested in pursuing a high level of professional training in lifestyle medicine, and who are committed to the expansion of lifestyle medicine education, programs, and initiatives to better serve their patients.

Learn more and apply for one of the scholarship awards.

May 16, 2023

ClaimsXten-Select™ for August 1, 2023

The ClaimsXten-Select™ upgrade is scheduled for Tuesday, August 1, 2023. Review full details here.

May 2, 2023

FEP Changes due to the end of the Public Health Emergency

Find details here.

May 2, 2023

COVID Temporary Codes U0003, U0004, and U0005

These temporary codes were established for use during the Public Health Emergency. As the PHE is ending on May 11, 2023 there codes are deleted. We are aligning with CMS/AMA, and our system is set up to deny the codes for dates of service May 12, 2023 or after as invalid.

April 25, 2023

Changes in Drugs New to Market (DNTM)

Effective July 1, 2023 there are changes in DNTM.

Find details here.

April 21, 2023

BCBSAR UM Changes for Walmart Health Plan

The Walmart Health Plan administered by BlueAdvantage of Arkansas (a subsidiary of Arkansas Blue Cross and Blue Shield) is piloting a new Utilization Management vendor, American Health Holding (AHH), for certain Utilization Management services incurred on or after May 1, 2023.

Find details here.

April 21, 2023

Temporary COVID-19 Payment Policies CPP_30 & CPP_31

CPP_30 Waiver of Cost Share for COVID-19 Related Testing, Diagnosis, and Inpatient Treatment
CPP_31 Waiver of Cost Share for COVID-19 Acute Outpatient Treatment

These two temporary COVID-19 Payment Policies are extended through June 30, 2023. These policies will expire on July 1, 2023, and benefits will be subject to the terms and conditions of the members certificates of coverage.

April 21, 2023

Update to Prior Approval Changes

We notified you on March 27, 2023, of changes to prior approval requirements for inpatient mental health and substance use disorder admissions, concurrent review and inpatient diversion level of care. There are updates to this notice.

Find the details of changes.

April 14, 2023

Frequently Asked Questions and Answers on Modifier  -25

Find details here.

April 7, 2023

Introduction to Risk Adjustment

Free Webinar on Wednesday, April 26, 2023.

Find details here.

April 7, 2023

Confidential Member Communication

Blue Cross VT members seeking care for sensitive issues (such as abortion care, gender affirming care, substance use, etc.) can request their Summary of Health Plan Payments (SHHP) be redirected. Their options include an email they designate - password protected, or a different mailing address than they currently have on file with Blue Cross VT or if they choose, completely suppressed with nothing sent at all.

Blue Cross VT members can receive support to make these changes in their SHPP by contacting the customer service team at the number on their ID card, or through the Member Resource Center portal.

Details related to this are also in our on-line Provider Handbook, starting on page 68:

March 31, 2023

The ending of the Public Health Emergency has NO impact on our TELEMEDICINE AND TELEHEALTH SERVICES Payment Policies.

View notice here.

March 31, 2023

Medical Policy Updates of June 1, 2023

Find the detail of updates here.

March 31, 2023

Community DME Breast Pump Supplies Update

Learn about the updates here.

March 27, 2023

New & Revised Codes for April 1, 2023 (Adaptive Maintenance)

Learn about new and revised codes here.

March 27, 2023

Attention Laboratories 

During the public health emergency period we allowed self-referrals for COVID-19 testing. Claims did not have to report an ordering provider. 

Effective May 11, 2023, COVID-19 testing requires a provider order. We are no longer allowing members to self-refer. In addition, the claim for the COVID-19 testing needs to indicate the ordering provider. These changes arise from the lifting of the public health emergency.

March 20, 2023

Outpatient Revenue Codes Requiring the reporting of HCPCS or CPT® Codes on Outpatient Claims

This document has been updated, effective April 1, 2023. The updates align with the new Cotiviti Edit for Revenue Code that is effective on April 1, 2023.

You can view the updated document here.

March 17, 2023

Update to Home Infusion Therapy Payment Policy (CPP_14)

The updates include the following:

  • HCPCS S9562 description updated to align with April 1, 2023, HCPCS description
  • HCPCS S9562 added, New HCPCS effective April 1, 2023
  • Update BCBSVT to be Blue Cross VT
  • Update Blue Cross VT URL's

You can view the new policy here.

March 14, 2023

Our online Prior Approval Database is live!

The online prior approval database is located on our Prior Approval Page by clicking the blue button at the top titled “Prior Approval Database”.

This searchable prior approval database takes the previous prior approval pdf document* and incorporates the prior approval procedures/items directly into the Blue Cross VT public website, offering three search options, as well as the ability to scroll through all the listings. Note: At this time, the FEP program and pharmacy/drugs are not included in this database. Please use the existing prior approval lists for these.

*the pdf version of the prior approval list will remain available until May 1, 2023.

There is a Quick Tips Guide posted to assist you with the Prior Approval Database.

March 13, 2023

Update to Telemedicine Payment Policy  (CPP_03) 

Effective May 1, 2023, the following services have been added to the Telemedicine Payment Policy: H0015, H0035, S0201, S9443, and S9480.

March 6, 2023

Three new Independent Laboratories added to the Blue Cross VT Network:

  • Adaptive Biotechnologies - Specialty, Immune Medicine
  • Foundation Medicine - Specialty, Genetics
  • Phenopath (under Quest Diagnostics) - Specialty, Oncology

The current list of all in-network Independent Laboratories is located here.

March 6, 2023

Updated Prefix Listing

The Prefix Listing has been updated to include some new CBA Blue prefixes.

March 6, 2023

UPDATE: Ambulatory Cardiac Monitors Medical Policy

On January 27, 2023, we notified you of an update to the Ambulatory Cardiac Monitors Medical Policy effective April 1, 2023. Those changes will not be going into effect and the existing Medical Policy will remain in place until further notice.

We apologize for any inconvenience.

March 6, 2023

Update: AIM and Radiology Prior Approval Changes

On January 30, 2023, we notified you of three upcoming changes, one of them being the transition of radiology prior approval to Carelon (formerly AIM Specialty Health) for NEHP/ABNE members. There is an unexpected delay with that transition. Until further notice, please resume sending radiology prior approval requests for NEHP/ABNE members to Blue Cross VT. The following changes were/will be implemented:

  • Effective March 1, 2023, AIM Specialty Health name is changing to Carelon Medical Benefits Management.
  • Effective April 9, 2023, Carelon Medical Benefits Management Advanced Imaging Appropriateness Guidelines are updated.

Find the details of changes here.

February 27, 2023

Update to Telemedicine Payment Policy (CPP_03)

The policy has been updated with the following retroactively back to January 1, 2023:

  • Added: 92526, 92601, 92602, 92603, 92604, 96105, 96121, 96125, 96156, 96158, 96165, 96167, 96168, 99418, 96170 (non-covered), and +96171 (non-covered).
  • Deleted the following services: 99241, 99251, 99354, 99355, 99356, and 99357 as no longer active with CPT® as of January 1, 2023.
  • Removed the * from these services: 92507, 92508, 92521, 92522, 92523, and 92524.
  • Revised the description of the following codes in Attachment 1 to align with the CPT® description changes for January 1, 2023: 99231, 99232, 99233, 99242, 99243, 99244, 99245, 99252, 99253, 99254, 99255, 99307, 99308, 99309, 99310, 99417, 99446, 99447, 99448, 99449, 99495, and 99496.
  • Revised the description of HCPCS code G2212

The updated policy is located here: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/

February 27, 2023

Services Temporarily Payable if delivered by Telemedicine Payment Policy (CPP_34)

This policy provided allowances for temporary coverage of (1) intensive outpatient therapy (2) partial hospitalization services and (3) lactatioin support through telemedicine.

The policy is expiring on May 1, 2023.

The intensive outpatient therapy and partial hospitalization services are eligible through our permanent Telemedicine Payment Policy (CPP_03) as of May 1, 2023. NOTE: The requirements of CPP_03 are different than what you are used to with CPP_34 and may change the eligiblity of the services you were providing. In addition, CPP_03 has very specific billing instructions that need to be followed.

Lactation support services are eligible through our permanent Telemedicine Payment Policy (CPP_03) as of May 1, 2023.

We are in the process of updating the Telemedicine Payment Policy (CPP_03) to include these services.

February 27, 2023

ClaimsXten-Select™ Upgrade

The ClaimsXten-Select™ upgrade is scheduled for Monday, May 1, 2023. Review the full details here.

February 13, 2023

Termination of Payment Policy CPP_34, Services Temporarily Payable if Delivered by Telemedicine

Effective May 1, 2023, the policy is terminated. Some services will become eligible for consideration of benefits through our permanent Telemedicine Payment Policy CPP_03. Updates are being made to CPP_03 and once completed, we will post a notice to this area with details.

February 13, 2023

Telephone Only Payment Policy (CPP_24) updates:

Effective May 1, 2023, the following codes are no longer eligible - 90849, 908534, 90863, 96127, +97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 99202, 99203, 99212, 99213, 99441, 99442, and 99443.

Effective retroactively to January 1, 2023, the following codes from Appendix "T" are added to the policy - 90833, 90836, 90838, 90839, 90840, 90845, 92507, 92508, 92521, 92522, 92523, 92524, 96116, +96121, 96156, 96158, +96159, 06164, +96165, 96167, +96168, 96170, and +96171.

The updated policy has been posted to the Provider Payment Policies.

February 8, 2023

Updated Notice on March 1, 2023, Medical Policy Updates

Find the detail of updates here.

Man playing games outside with his child

Provider Handbook

Access our Provider Handbook for a comprehensive reference of resources and requirements for Blue Cross providers.

Provider Handbook
a patient reviewing information with a provider

Academic Detailing and Prescription Support for Vermont Blue Rx

Our Clinical Pharmacist, Amy Stoll, PharmD, works with our providers on specific prescription questions, drug authorizations, and patient panel projects. Amy is a board-certified ambulatory care pharmacist, certified diabetes educator and has a master's degree in public health. Learn more about the services our team can provide to you.

Provider Prescription Support