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April 2018

Blue Cross changing practitioner fees July 1

Blue Cross Blue Shield of Michigan will change practitioner fees, effective with dates of service on or after July 1, 2018. This change applies to services provided to our Traditional, TRUST and Blue Preferred Plus℠, regardless of customer group. For most procedures, adjustments will reflect an average 2 percent increase in the conversion factors.

Blue Cross will use the 2018 Medicare resource-based relative value scale for most relative value unit-priced procedures for dates of service on and after July 1. Most fees are currently priced using the 2017 values. At the same time, the conversion factor used to calculate anesthesia base units for anesthesia procedures will remain $58.65 throughout Michigan.

Each year, Blue Cross adjusts its fee schedule to support an increase in value-based reimbursement. This is a continuation of the approach we’ve taken in the past as we transition from a strictly fee-for-service payment model to one where reimbursement reflects the overall value of services delivered to the patient.

Fee schedules effective July 1 will be available on web-DENIS on April 1. To find fee schedule information, go to the home page of web-DENIS and follow these steps:

  1. Click on BCBSM Provider Publications and Resources.
  2. Click on Entire Fee Schedules and Fee Changes. (After clicking on it, you’ll be asked to accept the End User Agreement.)

Only claims submitted with dates of service on or after July 1 will be reimbursed at the new rates.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.