Laboratory fee increases for select physician office lab tests

Blue Cross Blue Shield of Michigan pays health care providers an additional $5 per billing for LDL-C and HbA1c screening lab services, as of July 15, 2013. This is for services performed in a physician office setting for members with  PPO, Traditional and Medicare Advantage PPO plans when billed with the correct CPT^® Category II codes.

This increase impacts LDL-C screening procedure codes *83721 and *80061 (*80061 effective Aug. 7, 2013, for MA PPO) and HbA1c screening procedure code *83036. See the table below for the associated CPT Category II codes. CPT Category II codes must be reported on the same claim as the service to receive the additional reimbursement.

These CPT Category II codes represent results of the tests in the form of a range of values. For example, if a screening LDL cholesterol is performed in the office and the result is in the range of 100-129 mg/dL, this is reported by using CPT code *80061 (representing the test performed) and CPT II code *3049F (indicating that the result is in the 100-129 mg/dL range).

Using these codes will decrease the number of charts we will need to request to determine our Healthcare Effectiveness Data and Information Set performance.

CPT Category II codes describe components usually included in evaluation and management of clinical services, such as test results. When used, these codes may decrease the number of charts requested for review for HEDIS** purposes.

The following table lists the select lab tests with physician office-billable CPT Category I codes and the associated CPT Category II codes.

Select lab services with BCBSM-required use of CPT Category II codes:

On or after Oct. 15, 2013, BCBSM will no longer reimburse physician offices for laboratory services *83721, *80061 (date excludes MA PPO) and *83036 without submission of the associated CPT Category II codes. MA PPO will no longer reimburse *80061 without the submission of associated CPT Category II codes on or after Nov. 7, 2013. These details can be found in the July 15 and Aug. 7 web-DENIS broadcast messages. 

Look for future BCBSM communications regarding these dates.

If you have any questions, contact your BCBSM provider consultant..

**HEDIS^® is a registered trademark of the National Committee for Quality Assurance.