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March 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

29580

Basic Benefit and Medical Policy
Additional diagnosis codes 459.10, 459.11, 459.12, 459.13 and 459.19 payable for 29580.

Excluded for MESSA.

All speech therapy procedure codes

Basic Benefit and Medical Policy
The following diagnosis codes are now payable for speech therapy services:  433.00, 433.01, 433.10, 433.11, 433.20, 433.21, 433.30, 433.31, 433.80, 433.81, 433.90, 433.91, 434.00, 434.01, 434.10, 434.11, 434.90 and 434.91

This change does not apply to UAW Retiree Medical Benefits Trust.

83861

Payment Policy
Procedure code *83861 is payable in the physician’s office location, effective Sept. 1, 2013. This procedure code has been added to the Physician Office Laboratory List.

This procedure is not covered for auto groups, URMBT, MPSERS and State of Michigan.
POLICY CLARIFICATIONS

Revenue codes 0690-0696, 0699

Payment Policy
Effective Jan. 1, 2014, the National Uniform Billing Committee approved new revenue codes for prehospice and palliative care services.

Revenue code 0691 is replacing revenue code 0650 and requires visit counting. Report the number of visits in the unit field (form locator 46) of the UB-04 claim.

Inclusionary Guidelines
Twenty-eight visits are allowed for revenue code 0691, prior to the patient electing hospice care. Additional revenue codes are not a benefit for Michigan facilities.

20999, 38206, 38230, 38241

Note: Codes 20999, 38206, 38230 and 38241 are not reimbursable for orthopedic application of stem cell therapy.

Basic Benefit and Medical Policy
The medical policy statement for the Orthopedic Applications of Stem Cell Therapy policy has been updated. This policy is effective March 1, 2014.

Mesenchymal stem cell therapy and allograft bone products containing viable stem cells, including but not limited to demineralized bone matrix with stem cells are considered experimental for all orthopedic applications, including use in repair or regeneration of musculoskeletal tissue. The safety and efficacy of these treatments have not been established.
EXPERIMENTAL PROCEDURES

0004M

Basic Benefit and Medical Policy
DNA-based testing for adolescent idiopathic scoliosis is considered experimental. The peer-reviewed medical literature has not demonstrated the clinical utility of this testing.This policy is effective March 1, 2014.

0190T

Basic Benefit and Medical Policy
Intraocular placement of a radiation source and proton beam therapy for the treatment of choroidal neovascularization is considered experimental. These procedures have not been scientifically shown to be as safe and effective as conventional treatment. This policy is effective March 1, 2014.

0282T-0285T

Basic Benefit and Medical Policy
Peripheral subcutaneous field stimulation is considered experimental. It has not been scientifically demonstrated to improve patient clinical outcomes. This policy is effective March 1, 2014.

0335T, 28899, S2117

Basic Benefit and Medical Policy
Subtalar arthroereisis is considered experimental. It has not been scientifically demonstrated to be an effective treatment for the condition of flexible flatfoot. This policy is effective March 1, 2014.

81479*

*Specific code not available

Basic Benefit and Medical Policy
Whole exome sequencing is considered experimental.The peer-reviewed medical literature has not yet demonstrated the clinical utility of whole exome sequencing. This policy is effective March 1, 2014.

81506

Basic Benefit and Medical Policy
The peer reviewed medical literature has not demonstrated the clinical utility of multianalyte panels with algorithmic analysis (MAAA) for the prediction of Type 2 diabetes. Therefore, this service is considered experimental. This policy is effective March 1, 2014.

88375

Basic Benefit and Medical Policy
Confocal laser endomicroscopy is not an established procedure. Its safety and effectiveness in this clinical indication have not been scientifically determined. Therefore, confocal laser endomicroscopy is considered experimental. This policy is effective March 1, 2014.

92700*

* Specific code not available

Basic Benefit and Medical Policy
The vestibular autorotation test, also referred to as active head rotation, is considered experimental for the diagnosis of vestibular disorders. While this service may be safe, its effectiveness in this clinical indication has not been scientifically determined. This policy is effective March 1, 2014.
GROUP BENEFIT CHANGES

City of Detroit

Effective March 1, 2014, Medicare-eligible retirees of the City of Detroit 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. There will no longer be multiple PPO plan options for the retirees. The group number is 60421 with suffixes 605 through 611. 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.

Federal Screw Works, Options 3 and 4

Effective March 1, 2014, Medicare-eligible retirees of the Federal Screw Works, Options 3 and 4, 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 26418 with suffixes 602 and 603. 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.

Lenawee County Road Commission

Effective March 1, 2014, Medicare-eligible retirees of the Lenawee County Road Commission 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 60563 with suffixes 600 through 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.

McNaughton-McKay

Effective March 1, 2014, Medicare-eligible retirees of McNaugton-McKay 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 60575 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.
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 2013 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.