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January 2013
Blues highlight medical, benefit policy changes
You’ll find the latest information about procedure codes and Blue Cross Blue Shield of Michigan billing guidelines in the following chart.
This billing chart is organized numerically by procedure code. Newly approved procedures will appear under the New Payable Procedures heading. Procedures for which we have changed a billing guideline or added a new payable group will appear under Updates to Payable Procedures. Procedures for which we are clarifying our guidelines will appear under Policy Clarifications. New procedures that are not covered will appear under Experimental Procedures.
You will also see that descriptions for the codes are no longer included. This is a result of recent negotiations with the AMA on use of the codes.
We will publish information about new BCBS groups or changes to group benefits under the Group Benefit Changes heading.
For more detailed descriptions of the BCBSM policies for these procedures, please check under the Medical/Payment Policy tab in Explainer on web-DENIS. To access this online information:
- Log in to web-DENIS.
- Click on BCBSM Provider Publications & Resources.
- Click on Benefit Policy for a Code.
- Click on Topic.
- Under Topic Criteria, click the drop-down arrow next to Choose Identifier Type and then click on HCPCS Code.
- Enter the procedure code.
- Click on Finish.
- Click on Search.
| Code* |
BCBSM Changes to: Basic Benefit and Medical Policy,
Group Variations, Payment Policy, Guidelines |
| UPDATES TO PAYABLE PROCEDURES |
J2778 |
Inclusionary Guidelines
Effective Aug. 10, 2012, the Food and Drug Administration has approved this procedure as payable for diabetic macular edema (362.07). BCBSM is aligning with the Centers for Medicare & Medicaid Services’ policy to adopt this recommendation. |
| EXPERIMENTAL PROCEDURES |
90653 |
Basic Benefit and Medical Policy
Effective Jan. 1, 2013, the influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use is considered experimental. It has not been approved by the Food and Drug Administration. |
| 90685-90688 |
Basic Benefit and Medical Policy
Effective Jan. 1, 2013, the influenza virus vaccine, quadrivalent, for intramuscular use is considered experimental. It has not been approved by the FDA. |
| GROUP BENEFIT CHANGES |
| Alpena Regional Medical Center |
Alpena Regional Medical Center is adding a health savings account option and a flexible spending account option to its PPO plan offerings Jan. 1, 2013. The HSA and FSA will be administrated by BCBSM’s partner, Health Equity. |
| Auto Club Group |
Effective Jan. 1, 2013, Medicare-eligible retirees of Auto Club Group will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 26419 with suffixes 600-603. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| City of Grosse Pointe |
Effective Jan. 1, 2013, Medicare-eligible retirees of the City of Grosse Pointe will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 28840 with suffix 600. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans. Please note this group previously had Medicare Advantage coverage only and is now no longer part of the Grosse Pointe municipalities.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| City of Pontiac |
Effective Jan. 1, 2013, Medicare-eligible retirees of the City of Pontiac will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 52219 with suffixes 600-602. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| Demmer Corporation |
Demmer Corporation will join the Blues Jan. 1, 2013. The group has five affiliated locations offering the following plans:
- Demmer Corporation – PPO High Plan 1 and PPO Low Plan 2
- Intrex – Two PPO plans
- Jonaco – A PPO plan and a high-deductible health plan with a health savings account
- ELO – A PPO plan and a high-deductible health plan with a health savings account
- Quality Tool – A PPO plan
Member ID cards will show alpha prefix DEM. |
| Dickenson County Library |
Effective Jan. 1, 2013, Medicare-eligible retirees of the Dickenson County Library will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 27387 with suffix 600. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| Gestamp North America |
Gestamp North America, group number 71525, is adding a Health Equity health savings account and prescription drug coverage Jan. 1, 2013. New section codes are 4000, 4001 and 4002. New package codes are 011, 012, 021, 022, 031, 032, 041, 042, 051, 052, 061 and 062. |
| IMA/AA/CAMRYN (formerly Integrated Manufacturing and Assembly) |
IMA/AA/CAMRYN, group number 71572, will migrate from the Michigan Operating System to the NASCO platform with the Blues on Jan. 1, 2013. There are approximately 500 Anthem Blue Cross Blue Shield contracts that will be migrated to NASCO as well. The group will offer seven PPO plans with medical-surgical coverage, six prescription drug plans and four vision plans with VSP coverage.
Member ID cards will show alpha prefix MUR for PPO coverage and XYX for Medicare. |
| International Brotherhood of Electrical Workers Local 252 |
Effective Jan. 1, 2013, Medicare-eligible retirees of the International Brotherhood of Electrical Workers Local 252 will have Blue Cross Blue Shield of Michigans Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 59817 with suffix 600. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| Iron Workers Local 340 |
Effective Jan. 1, 2013, Medicare-eligible retirees of Iron Workers Local 340 will have Blue Cross Blue Shield of Michigans Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 27203 with suffix 600. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| Lacks Enterprise |
Lacks Enterprise, group number 71428, will add a new PPO and VBID plan with prescription drug, dental and VSP vision coverage, effective Jan. 1, 2013.
The group has also made the following benefit changes:
- Dental – Class 1 services are covered at 100 percent.
- Medical deductible – In network, $750 individual and $1,500 family; out of network, $2,250 individual and $4,500 family
Out-of-pocket maximum – In network, $1,000 individual and $2,000 family; out of network, $2,000 individual and $4,000 family |
| Macomb County |
Effective Jan. 1, 2013, Medicare-eligible retirees of Macomb County will have Blue Cross Blue Shield of Michigans Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 59905 with suffixes 600-601. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| Michigan Catholic Conference Lay Clergy |
Effective Jan. 1, 2013, Medicare-eligible retirees of the Michigan Catholic Conference Lay Clergy will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 26485 with suffixes 601-611, 621-631, 641-651 and 661-671. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| Orchid Orthopedic Solutions |
Orchid Orthopedic Solutions, group number 71562, is changing its members’ coverage, effective Jan. 1, 2013.
The group will offer a PPO plan with prescription drug, vision and hearing coverage and a health reimbursement arrangement and flexible spending account. Deductibles are $3,000 per member and $6,000 per family in network, and $6,000 per member and $12,000 per family out of network.
Member ID cards will show alpha prefix ORH. |
| Portage Health |
Portage Health in the Upper Peninsula, group number 71443, will add a new high-deductible health plan with prescription drug benefits and a health savings account to its existing PPO plans, effective Jan. 1, 2013. The group will offer a triple-tier hospital HSA plan:
- Tier 1 — Portage Health facility and designated providers
- Tier 2 — In-network PPO providers located in Michigan
- Tier 3 — Out-of-network and out-of-state providers
Section codes will be 4000, 4001. Package codes will be 241, 242, 243, 244, 245, 246, 247 and 248. Existing members will not receive new ID cards. To verify a member’s benefits or eligibility, call 1-800-482-5141. |
| Roskam Baking Company |
Roskam Baking Company, group number 71561, is adding a high-deductible PPO health plan with a health saving account to its benefits Jan. 1, 2013. Member ID cards will show alpha prefix RMH. |
| Saginaw Plumbers & Pipefitters UA Local 85 |
Effective Jan. 1, 2013, Medicare-eligible retirees of the Saginaw Plumbers & Pipefitters UA Local 85 will have Blue Cross Blue Shield of Michigans Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 26562 with suffix 600. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| Saginaw Valley State University |
Effective Jan. 1, 2013, Medicare-eligible retirees of Saginaw Valley State University will have Blue Cross Blue Shield of Michigans Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 59817 with suffix 600. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| Sheet Metal Local 7 Zone 2 |
Effective Jan. 1, 2013, Medicare-eligible retirees of the Sheet Metal Local 7 Zone 2 will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 26533 with suffix 600. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| Sheet Metal Local 7 Zone 4 |
Effective Jan. 1, 2013, Medicare-eligible retirees of the Sheet Metal Local 7 Zone 4 will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 26561 with suffix 600. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| St. Clair County |
Effective Jan. 1, 2013, Medicare-eligible retirees of the St. Clair County will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical, surgical and prescription drug benefits. The group number is 59830 with suffixes 600-605. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
| TrelleborgVibracoustic |
TrelleborgVibracoustic, group number 71570, will join the Blues Jan. 1, 2013.
This group has two segments. Dawson has PPO, dental, vision and prescription drug coverage. TrelleborgVibracoustic has PPO, PPO with a health reimbursement arrangement, dental, vision and prescription drug coverage, and a CMM plan |
| UAW Retiree of ACC Benefit |
Effective Jan. 1, 2013, Medicare-eligible retirees of the UAW Retiree of ACC Benefit Trust will have Blue Cross Blue Shield of Michigans Medicare Advantage PPO plan, Medicare Plus Blue Group PPOSM, for their medical and surgical benefits. The group number is 27356 with suffix 600. You can identify members by the XYL prefix on their ID cards, like those of other Medicare Plus Blue Group PPO plans.
For information about our Medicare Advantage PPO plan, go to bcbsm.com/provider/ma. |
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