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January 2014
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 |
76942 |
Basic Benefit and Medical Policy
The PPO Radiology Management Program has added procedure code *76942 to the program for provider specialty neurologist, effective Sept. 1, 2013. |
B4185 |
Basic Benefit and Medical Policy
CLINOLIPID injection (lipid injectable emulsion, for intravenous use) is covered for adult patients, effective Oct. 4, 2013. |
J7199 |
Basic Benefit and Medical Policy
RIXUBIS (Coagulation Factor IX [Recombinant]) is covered for routine prophylactic treatment, control of bleeding episodes and perioperative management in people who are 16 or older with hemophilia B when reported with J7199, effective June 28, 2013. |
| POLICY CLARIFICATIONS |
96150-96154 |
Basic Benefit and Medical Policy
Clinical licensed master’s social workers are considered payable providers for these procedures. |
99201-99205, 99211-99215, 99217-99223, 99231-99236, 99238, 99239, 99304-99310, 99315, 99316, 99318, 99324-99328, 99334-99337, 99341-99345, 99347-99350 |
Payment Policy
The procedure codes listed at left are not payable to a psychologist, effective Oct. 1, 2013. This change does not apply to the Federal Employee Program®. |
Revenue code 0960 |
Payment Policy
Payable locations: Inpatient, outpatient, residential substance abuse facility and outpatient substance abuse facility. |
Revenue codes 1001, 1002 |
Payment Policy
The National Uniform Billing Committee has clarified the behavioral health residential accommodations language by removing the word “treatment” from the descriptions of revenue codes 1001 and 1002.
The revenue code category is intended for use on 086X type of bills. |
| EXPERIMENTAL PROCEDURES |
81500, 81503 |
Basic Benefit and Medical Policy
Proteomics-based testing for the evaluation of ovarian (adnexal) masses (e.g., OVA1® and ROMA™ tests) is considered experimental. The use of this testing has not been scientifically demonstrated to improve patient clinical outcomes.
This policy is effective Sept. 1, 2013. |
| GROUP BENEFIT CHANGES |
Alta Equipment Company |
Alta Equipment Company, group number 71582, will join the Blues, effective Jan. 1, 2014. The group will offer a PPO plan with medical-surgical coverage and a prescription drug plan.
Member ID cards will indicate alpha prefix GLT. |
Aspirus-Keweenaw Hospital |
Aspirus-Keweenaw Hospital is a hospital group currently housed on the NASCO platform, but it will be moving to the MOS platform, effective Jan. 1, 2014. The new MOS group number will be 007004132. Member ID cards will continue to retain the existing alpha prefix of KEW. Aspirus Keweenaw Hospital employees will be offered medical, drug, dental and vision benefits. |
City of Grosse Pointe Park |
Effective Jan. 1, 2014, Medicare-eligible retirees of the City of Grosse Pointe Park will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus BlueSM Group PPO, for their medical, surgical and prescription drug benefits. The group number is 51567 with suffixes 601 and 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. |
City of Huntington Woods |
Effective Jan. 1, 2014, Medicare-eligible retirees of the City of Huntington Woods will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus BlueSM Group PPO, for their medical, surgical and prescription drug benefits. The group number is 60480 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. |
City of Pontiac |
Effective Jan. 1, 2014, Medicare-eligible retirees of the City of Pontiac will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus BlueSM Group PPO, for their medical, surgical and prescription drug benefits. The group number is 60418 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. |
County of Wayne |
Effective Jan. 1, 2014, Medicare-eligible retirees of the County of Wayne will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PDP plan, Prescription BlueSM, for their prescription drug benefits. The group number is 60456 with suffixes 600, 601 and 602. You can identify members by the XYA 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. |
Dickinson County Health System |
Dickinson County Health System is a hospital group currently housed on the NASCO platform, but it will be moving to the MOS platform, effective Jan. 1, 2014. The new MOS group number will be 007003630. Member ID cards will continue to retain the existing alpha prefix of DHE. Dickinson County Health System employees will be offered medical and dental benefits. |
Frankenmuth Insurance |
Effective Jan. 1, 2014, Medicare-eligible retirees of Frankenmuth Insurance will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus BlueSM Group PPO, for their medical, surgical and prescription drug benefits. The group number is 60423 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. |
Henniges Automotive |
Effective Jan. 1, 2014, Henniges Automotive, group number 71325, members have Catamaran as their prescription drug carrier, instead of Express Scripts. Members will receive a new BCBSM card that will no longer have a prescription drug phone number on it. They will also receive Catamaran cards with information regarding their new prescription drug plan. |
Huron Clinton Metropolitan Authority |
Effective Jan. 1, 2014, Medicare-eligible retirees of the Huron Clinton Metropolitan Authority will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus BlueSM Group PPO, for their medical, surgical and prescription drug benefits. The group number is 67228 with suffix 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. |
Local 4911 VEBA Trust |
Effective Jan. 1, 2014, Medicare-eligible retirees of Local 4911 VEBA Trust will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus BlueSM Group PPO, for their medical, surgical and prescription drug benefits. The group number is 60426 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. |
Michigan Electrical Employees Health Plan |
Effective Jan. 1, 2014, Medicare-eligible retirees of the Michigan Electrical Employees Health Plan will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus BlueSM Group PPO, for their medical, surgical and prescription drug benefits. The group number is 60447 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. |
Neogen Corporation |
Neogen Corporation, group number 71578, will transition from local MOS to NASCO, effective Jan. 1, 2014. The group offers four PPO plans with medical-surgical coverage and two prescription drug plans.
Member ID cards will show alpha prefixes DMM. |
Severstal North America Hourly |
Claims processing for Severstal North America Hourly, group number 72730, will move from our local MOS to NASCO processing system Jan. 1, 2014. The group is offering one PPO plan with hearing, dental and Traditional vision coverage and one prescription drug plan.
Member ID cards will show the following alpha prefixes:
GVJ – for PPO plans
GVL – for Medicare PPO |
Sturgis Hospital Inc. |
Sturgis Hospital Inc., group number 71580, will join the Blues Jan. 1, 2014. The group will offer two PPO plans, a health savings account (being managed outside BCBSM) and two prescription drug plans.
Member ID cards will show alpha prefix AIB. |
UAW Retiree Trust |
Effective Jan. 1, 2014, Medicare-eligible retirees of the UAW Trust will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus BlueSM Group PPO, for their medical, surgical and prescription drug benefits, expanding coverage to group members in Michigan, Florida, Missouri and West Virginia. The plan ID number for Michigan is 2040165. 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. |
Wacker Chemical |
Effective Jan. 1, 2014, Medicare-eligible retirees of Wacker Chemical will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus BlueSM Group PPO, for their medical, surgical and prescription drug benefits. The group number is 60156 with suffixes 600 and 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. |
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