New procedure code authorized for outpatient hospital clinic visits

Starting Jan. 1, 2014, the Centers for Medicare & Medicaid Services eliminated the use of evaluation and management Current Procedural Terminology codes *99201-*99205 and *99211-*99215 for hospital outpatient clinic visits for all Medicare patients. CMS now requires health care providers to bill the new Health Care Procedure Coding System code G0463 for E&M hospital outpatient clinic visits for all Medicare patients. The *99201-*99205 and *99211-*99215 codes are still appropriate and valid for place of service.

Commercial
Blue Cross Blue Shield of Michigan will continue to accept the E&M CPT codes for clinic visits for outpatient hospital services on the CMS-1500 claim form.

BCBSM will not reimburse facilities or professional providers for procedure code G0463 for clinic services for commercial business in Michigan. However, we will reimburse G0463 for Medicare secondary claims.

For more information about billing for clinic E&M services, see the related article in the March 2013 issue of The Record or contact your provider consultant.

Medicare Advantage
BCBSM’s Medicare Advantage will comply with the CMS requirement. The implementation date will be shared as soon as available. Medicare Advantage PPO will not reimburse facilities that bill using E&M CPT codes *99201-*99205 and *99211-*99215 for clinic visits for E&M outpatient hospital services after the system is modified. Adjustments will be made once the change is made.

This change applies to outpatient hospital services only and does not affect professional services provided at the point of service.