The Record - for physicians and other health care providers to share with their office staffs
April 2013

BCBSM to change professional provider fees July 1

BCBSM will change practitioner fees, effective with dates of service on or after July 1, 2013, for services provided to our Traditional, TRUST and Blue Preferred PlusSM members, regardless of customer group.

BCBSM will use the 2013 Medicare resource-based relative value scale for all relative value unit-priced procedures for dates of service on and after July 1. Most fees are currently priced using the 2012 values.

Changes in RBRVS values can impact fees. Procedure code maximum fees will increase or decrease based on the new relative value units and BCBSM’s conversion factors.

At the same time, the non-RVU-based anesthesia services will be increased by 1.3 percent in West Michigan and the rest of the state.

We conduct a comprehensive analysis of professional provider performance and current economic indicators annually to calculate practitioner fees, with consideration for corporate and customer cost concerns. BCBSM remains committed to reviewing professional provider performance to determine the need for increases or decreases in our maximum payments.

Fee schedules with the new fees that are effective July 1 will be available on web-DENIS April 1. Click on Entire Fee Schedules and Fee Changes on the web-DENIS BCBSM Provider Publications and Resources page to find fee information.

Please do not resubmit claims with dates of service prior to July 1, 2013. Only claims submitted with dates of service on or after July 1 will be reimbursed at the new rates.

For more information, contact your BCBSM provider consultant.

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 2012 American Medical Association. All rights reserved.