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October 2013

Providers of outpatient abortion services must comply with new state law to receive reimbursements

Providers who advertise outpatient abortion services and perform more than 120 abortions in their offices in a year are required by law to be licensed as a freestanding outpatient surgical facility. This requirement is the result of Public Act 499 of 2012, which took effect March 31, 2013. The law also creates additional requirements and provisions for performing abortion services.

Blue Cross Blue Shield of Michigan will not pay for covered abortion services if providers fail to comply with Public Act 499 of 2012. We will attempt to recover all reimbursements paid to the provider during the time the provider is out of compliance. In addition, the provider’s participation agreement may be terminated.

Physicians operating freestanding outpatient surgical facilities under this law are not necessarily part of the Blue Cross ambulatory surgical facility provider class and would have to apply to participate as an ambulatory surgical facility. Otherwise, physicians performing abortion services in these settings should continue to bill BCBSM as a physician office location.

Please contact your provider consultant if you have any questions.

The information in this article is not intended to provide legal advice. If you have any legal questions about this subject, you should consult your attorney or other professional legal services provider.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
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