The Record - Blues highlight medical, benefit policy changes

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:

Click on BCBSM Provider Publications & Resources.

Click on Benefit Policy for a Code.

Click on Topic.

Under Topic Criteria, click on 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

NEW PAYABLE PROCEDURES

Established
81240, 81241

Experimental
81291

Basic Benefit and Medical Policy
Medical Policy has determined that genetic testing for factor V Leiden mutations and prothrombin gene mutations for inherited thrombophilia has been established in select patient populations who meet clinical criteria. This testing may be a useful diagnostic option when indicated.

Genetic testing for mutations in the MTHFR gene is considered experimental. There is limited published evidence on the utility of testing for MTHFR mutations for inherited thrombophilia. This policy is effective Jan. 1, 2014.

Inclusionary Guidelines
Genetic testing for factor V Leiden gene mutations and prothrombin gene mutations for inherited thrombophilia should only be performed if the results are likely to direct or alter medical management in any of the following:

Patients with VTE occurring at 50 years of age or younger
Patients with VTE at any age who have a first-degree family member with a history of VTE
Asymptomatic or symptomatic family members (first-degree relatives) of patients with a known familial thrombophilia
Patients with VTE in unusual sites, such as hepatic, mesenteric, renal or cerebral veins
Women with recurrent pregnancy loss or unexplained severe preeclampsia, placental abruption, intrauterine growth retardation or stillbirth when the knowledge of inherited thrombophilia carrier status will influence the management of future pregnancies
Patients with VTE provoked by pregnancy, the puerperium (post-partum period), oral contraceptive use or hormone replacement therapy

Exclusionary Guidelines

Genetic testing for mutations in the MTHFR gene
As a general population screen
Asymptomatic patients with no personal or familial history of VTE
As a routine test prior to the use of oral contraceptives, hormone replacement therapy, selective estrogen receptor modulators or tamoxifen
As a routine prenatal or newborn test, or as a routine test in asymptomatic children
As a routine test in individuals with arterial thrombosis

J7199

Basic Benefit and Medical Policy
Tretten is established as safe and effective for its FDA-approved indication: to prevent bleeding in adults and children with congenital factor XIII A subunit deficiency. This policy is effective Dec. 23, 2013.

Tretten should be reported with the not-otherwise-classified code J7199 until a permanent code is established.

Tretten is for intravenous use only.

Dose:

35 international units per kilogram body weight once monthly to achieve a target trough level of FXIII activity at or above 10 percent using a validated assay.
Consider dose adjustment if adequate coverage is not achieved with a 35 IU/kg dose.
Once reconstituted, tretten may be diluted with 0.9 percent sodium chloride to facilitate measurement of small volumes.

Inclusionary Guidelines
Tretten (coagulation factor XIII A-subunit (recombinant)) indicated for:

Routine prophylaxis of bleeding in people with congenital FXIII A-subunit deficiency.

Exclusionary Guidelines

Tretten is not approved for use in patients with congenital FXIII B-subunit deficiency

UPDATES TO PAYABLE PROCEDURES

0005M, 81599

Basic Benefit and Medical Policy
Nucleic acid sequencing-based testing of maternal plasma for trisomy 21 may be considered established in women with high-risk singleton pregnancies undergoing screening for trisomy 21. Karyotyping would be necessary to exclude the possibility of a false positive nucleic acid sequencing-based test. Before testing, women should be counseled about the risk of a false positive test.

Nucleic acid sequencing-based testing of maternal plasma for trisomy 21 in women who do not meet the above criteria is considered experimental.

Group Variations
Payable for GM hourly and salaried enrollees, effective Sept. 20, 2013.

20982, 32998

Basic Benefit and Medical Policy
The safety and effectiveness of radiofrequency ablation of osteoid osteomas have been established. It may be considered a useful therapeutic option when indicated.

The safety and effectiveness of radiofrequency ablation to palliate pain in patients with osteolytic bone metastases have been established. It may be considered a useful therapeutic option when indicated.

The safety and effectiveness of radiofrequency ablation of renal tumors have been established. It may be considered a useful therapeutic option when indicated

Radiofrequency ablation is an established treatment option in selected patients with primary, non-small cell lung cancer and metastatic pulmonary tumors who are not candidates for surgical intervention.

Group Variations
Payable for Chrysler salaried groups, effective Jan. 1, 2014.

83861

Basic Benefit and Medical Policy
Tear osmolarity testing may be considered established as indicated for the diagnosis and monitoring of Dry Eye Syndrome if slit lamp, as well as two other tests, fail to establish the suspected diagnosis of dry eye syndrome.

Additional tests may include:

Schirmer’s test
Tear evaporation test
Tear break up time
Ocular staining

Tear osmolarity testing is considered experimental for all other indications.

Group Variations
Payable for GM hourly and salaried enrollees, effective Sept. 20, 2013.

90471, 90736

Group Variations
Effective Jan. 1, 2014, direct reimbursement is allowed to a pharmacy for procedure codes *90471 and *90736 for Ford salaried non-Medicare members.

POLICY CLARIFICATIONS

22856, 22861, 22864

Basic Benefit and Medical Policy
The safety and effectiveness of the insertion of cervical artificial intervertebral discs have been established. It is a useful therapeutic option for patients meeting patient selection criteria. This policy is effective May 1, 2013.

Group Variations
Not payable for GM, Delphi, Ford, Chrysler and URMBT

Inclusionary Guidelines (Must meet all)

The device being used must have final FDA approval.
Patients must:

Be skeletally mature (no further growth in height is anticipated) and
Have one level disk disease, such as a herniated disc or spondylosis, as defined by the presence of osteophytes, in the region of C3-7, confirmed by imaging (X-ray, MRI, etc.) and
Exhibit symptomatic cervical disc disease, including neck or arm (radicular) pain that may include functional or neurological deficits and
Have undergone a minimum of six weeks’ active conservative therapies, including:

Formal active physical therapy program and
The use of prescription oral analgesic medications or anti-inflammatories and
Interventional steroid injection (if indicated)

Exclusionary Guidelines

Patients not meeting the above patient selection criteria.
Use of implants in multi-level disc repair
More than one vertebral level with SCDD
Isolated axial neck pain
Prior fusion surgery at an adjacent vertebral level
Prior surgery at the level to be treated
Patients with progressive symptoms and signs of spinal cord or nerve root compression with less than six weeks of conservative treatments
Facet joint disease, arthropathy or degeneration at the level to be treated
Neck or arm pain of unknown etiology
Paget’s disease, osteomalacia, osteoporosis or other metabolic bone disease
Pregnancy
Current medications known to interfere with bone or soft tissue healing (e.g., steroids)
Rheumatoid arthritis or other autoimmune disease
Ankylosing spondylitis
Insulin dependent diabetes mellitus
Systemic disease including AIDS, HIV and hepatitis
Active malignancy

55875, 77326-77328, 77402-77404, 77406, 77776-77778, **G0458, Q3001
** Procedure requires individual consideration, documentation required

Basic Benefit and Medical Policy
Brachytherapy for clinically localized prostate cancer using permanently implanted seeds policy has been updated. This policy is effective March 1, 2014.

Medical Policy Statement
Brachytherapy using permanent transperineal implantation of radioactive seeds has been established as a safe and effective treatment of localized prostate cancer when used as monotherapy or in conjunction with external beam radiation therapy.

Focal or subtotal prostate brachytherapy is considered experimental in the treatment of prostate cancer. Its effectiveness in this clinical indication has not been scientifically determined.

Inclusionary Guidelines
Permanent brachytherapy using only implanted seeds is generally used in patients whose prostate cancer is considered low risk. Active surveillance is generally recommended for very low risk prostate cancer. Permanent brachytherapy combined with EBRT is used (sometimes along with androgen deprivation) to treat higher-risk disease.

Prostate cancer risk is often defined using the following criteria:

Low risk: prostate-specific antigen 910 ng/mL or less 0, Gleason score 6 or less and clinical stage T1c (very low risk) or T1-T2a
Intermediate risk: PSA greater than 10 but 20 ng/mL or less, or Gleason score 7 or clinical stage T2b-T2c
High risk: PSA >20 ng/mL or Gleason score 8-10, or clinical stage T3a for clinically localized disease and T3b-T4 for locally advanced disease

The procedure is usually performed in two stages: a prostate volume study followed at a later date by the implant itself, which is performed in the operating room with the patient under general or epidural anesthesia. Iodine and palladium are the typical isotopes used; the selection of isotope is usually based on physician preference. A computed tomography scan is usually performed at some stage after the procedure to determine the accuracy of the seed placement.

Exclusionary Guidelines
Focal or subtotal prostate brachytherapy

59025

Basic Benefit and Medical Policy
When billing two fetal non-stress tests on the same day, report each service on separate service lines. On consecutive service lines, modifier 76 must be reported to denote that the service was repeated.

64561, 64581, 64585, 64590, 64595, 95970-
95973, A4290, E0745, E1399, L8680, L8685-L8688

Basic Benefit and Medical Policy
The criteria for the sacral nerve neuromodulation/stimulation policy have been updated. This policy is effective Nov. 1, 2013.

Urinary Incontinence and Non-obstructive Retention
Inclusionary Guidelines

A trial period of sacral nerve neuromodulation with either percutaneous nerve stimulation or a temporarily implanted lead is established in patients who meet all of the following criteria:

There is a diagnosis of at least one of the following:

Urge incontinence
Urgency-frequency syndrome
Non-obstructive urinary retention

There is documented failure or intolerance to at least two conventional therapies (e.g., behavioral training, such as bladder training, prompted voiding or pelvic muscle exercise training, pharmacologic treatment for at least a sufficient duration to fully assess its efficacy or surgical corrective therapy).
The patient is an appropriate surgical candidate.
Incontinence is not related to a neurologic condition.

Permanent implantation of a sacral nerve neuromodulation device is established in patients who meet all of the following criteria:

All of the criteria in A (1-4) above are met.
A trial stimulation period demonstrates at least 50 percent improvement in symptoms over a period of at least one week

Exclusionary Guidelines
Other urinary or voiding applications of sacral nerve neuromodulation are considered experimental, including, but not limited to, treatment of stress incontinence or urge incontinence due to a neurologic condition, e.g., detrusor hyperreflexia, multiple sclerosis, spinal cord injury or other types of chronic voiding dysfunction.

Fecal incontinence
Inclusionary Guidelines
Sacral nerve neuromodulation is established for the treatment of fecal incontinence when all of the following criteria are met:

A trial period of sacral nerve neuromodulation with either percutaneous nerve stimulation or a temporarily implanted lead may be considered established in patients who meet all of the following criteria:

There is a diagnosis of chronic fecal incontinence of greater than two incontinent episodes on average per week with duration greater than six months or for more than 12 months after vaginal childbirth.
There is documented failure or intolerance to conventional conservative therapy (e.g., dietary modification, the addition of bulking and pharmacologic treatment for at least a sufficient duration to fully assess its efficacy, performed more than 12 months [or 24 months in the case of cancer] previously).
The patient is an appropriate surgical candidate.
The condition is not related to an anorectal malformation (e.g., congenital anorectal malformation, defects of the external anal sphincter over 60 degrees, visible sequelae of pelvic radiation, active anal abscesses and fistulae) or chronic inflammatory bowel disease.
Incontinence is not related to a neurologic condition.

Permanent implantation of a sacral nerve neuromodulation device may be considered established in patients who meet all of the following criteria:

All of the criteria in A (1-5) above are met.
A trial stimulation period demonstrates at least 50 percent improvement in symptoms over a period of at least one week.

Exclusionary Guidelines
Sacral nerve neuromodulation is considered experimental for the treatment of chronic constipation or chronic pelvic pain.

Established
78608, 78609, 78811-78813, G0235

Experimental
G0219, G0252

Basic Benefit and Medical Policy
The effectiveness of positron emission tomography scanning for selected oncologic applications have been established. It is a useful diagnostic option for patients meeting selection criteria. This policy is effective July 1, 2014.

Inclusionary and Exclusionary Guidelines
All inclusionary and exclusionary statements apply to both positron emission tomography scans and PET/computed tomography scans, such as PET scans with or without PET/CT fusion.

A PET or PET/CT may be appropriate for a patient with known diagnosis of a malignancy in order to determine the optimal anatomic site for a biopsy or other invasive diagnostic procedure if standard imaging is equivocal. It also may replace conventional imaging when conventional imaging would be inadequate for accurate staging, and when clinical management will depend upon the stage of disease. In general, for most solid tumors, a tissue diagnosis is made prior to the performance of PET scanning. PET scans following a tissue diagnosis are performed for the purpose of staging, not diagnosis. If the results of the PET scan will not influence treatment decisions, these situations would be considered not medically necessary.

PET scans may be considered appropriate for the following oncologic conditions:

Anal cancer
Inclusionary Guidelines

For the diagnosis, staging, restaging and monitoring of anal cancer

Exclusionary Guidelines

Conditions not listed above

Bone cancer
Inclusionary Guidelines

For the staging of Ewing sarcoma and osteosarcoma

Exclusionary Guidelines

For the staging of chondrosarcoma

Brain cancer
Inclusionary Guidelines

For diagnosis and staging, where lesions metastatic from the brain are identified but no primary is found
For restaging, to distinguish recurrent tumor from radiation necrosis

Exclusionary Guidelines

Conditions not listed above

Breast cancer
Inclusionary Guidelines
For the initial and subsequent treatment strategy:

In the evaluation of a patient with axillary nodal metastasis of unknown primary origin
For the detection of distant (non-axillary) metastatic disease in high-risk patients with known breast cancer. This includes, but is not limited to:

Patients with clinically suspicious axillary lymph nodes (palpable, matted or highly suspicious on imaging study), to avoid the need for an unnecessary lymph node procedure in a patient who might already have metastatic disease or would require chemotherapy prior to surgery and
Patients with locally advanced disease prior to planned neoadjuvant therapy (prior to surgery), particularly when standard imaging is equivocal or suspicious

Exclusionary Guidelines

For the differential diagnosis in patients with suspicious breast lesions or an indeterminate or low suspicion finding on mammography
For predicting pathologic response to neoadjuvant therapy for locally advanced disease.

Cancers of unknown primary
Inclusionary Guidelines

Patients with an unknown primary who meet all of the following criteria:

In patients with a single site of disease outside the cervical lymph nodes
Patient is considering local or regional treatment for a single site of metastatic disease
Patient has received a negative workup for a occult primary tumor
The PET scan will be used to rule out or detect additional sites of disease that would eliminate the rationale for local or regional treatment.

Exclusionary Guidelines

For patients with an unknown primary, including, but not limited to, the following:

As part of the initial workup of an unknown primary
As part of the workup of patients with multiple sites of disease

Cervical cancer
Inclusionary Guidelines

For the initial staging of patients with locally advanced cervical cancer
For the evaluation of known or suspected recurrence

Exclusionary Guidelines

For the initial diagnosis of cervical cancer in all other situations

Colorectal cancer
Inclusionary Guidelines

Staging and restaging (initial and subsequent treatment strategy) to detect and assess resectability of hepatic or extrahepatic metastases of colorectal cancer and
To evaluate a rising and persistently elevated carcinoembryonic antigen level when standard imaging, including CT scan, is negative

Exclusionary Guidelines

When used as a technique to assess the presence of scarring versus local bowel recurrence in patients with previously resected colorectal cancer.
When used as a technique contributing to radiotherapy treatment planning.

Esophageal cancer
Inclusionary Guidelines

Staging and restaging of esophageal cancer and
Determining response to preoperative induction therapy

Exclusionary Guidelines

Detection of primary esophageal cancer.

Gastric (stomach) cancer
Inclusionary Guidelines

Diagnosis, staging and restaging of gastric carcinoma if other imaging is inconclusive
Determining response to preoperative induction therapy.

Exclusionary Guidelines

Conditions not listed above

Head and neck cancer
Inclusionary Guidelines

For the evaluation of the head and neck in the diagnosis of suspected head and neck cancer
For the initial staging of the disease
For restaging of residual or recurrent disease during follow up after treatment for their head and neck cancer

Exclusionary Guidelines

Conditions not listed above

Lung cancer
Inclusionary Guidelines

Patients with a solitary pulmonary nodule as a single-scan technique (not dual-time) to distinguish between benign and malignant disease when prior CT scan and chest X-ray findings are inconclusive or discordant
To determine resectability for patients with a presumed solitary metastatic lesion from lung cancer
As a staging or restaging technique in those with known non-small-cell lung cancer

Exclusionary Guidelines

As a staging or restaging technique of small cell lung cancer
Conditions not listed above.

Lymphoma, including Hodgkin’s disease
Inclusionary Guidelines

PET scanning as a technique for staging lymphoma either during initial staging or for restaging at follow-up

Exclusionary Guidelines

Conditions not listed above

Melanoma
Inclusionary Guidelines

Assessing extranodal spread of malignant melanoma at initial staging or at restaging during follow-up treatment.

Exclusionary Guidelines

When used as a technique to detect regional lymph node metastases in patients with clinically localized melanoma who are candidates to undergo sentinel node biopsy

Multiple myeloma
Inclusionary Guidelines

For the initial and subsequent treatment strategy of multiple myeloma

Exclusionary Guidelines

Not applicable

Neuroendocrine tumors
Inclusionary Guidelines

For the diagnosis, staging, restaging and monitoring of neuroendocrine tumors

Exclusionary Guidelines

Conditions not listed above

Ovarian cancer
Inclusionary Guidelines

Initial staging of ovarian cancer
For the evaluation of patients with signs or symptoms of suspected ovarian cancer recurrence (restaging) when standard imaging, including CT scan, is inconclusive.

Exclusionary Guidelines

For the initial evaluation (not staging) of known or suspected ovarian cancer in all other situations

Pancreatic cancer
Inclusionary Guidelines

For the initial diagnosis and staging of pancreatic cancer when other imaging and biopsy are inconclusive.

Exclusionary Guidelines

Evaluating other aspects of pancreatic cancer

Penile cancer
Inclusionary Guidelines

Staging inguinal lymph nodes in patients with squamous cell carcinoma of the penis.

Exclusionary Guidelines

All other indications

Prostate cancer
Inclusionary Guidelines

Not applicable

Exclusionary Guidelines

For the diagnosis and management of known or suspected prostate cancer.

Soft tissue sarcoma
Inclusionary Guidelines

For initial staging prior to resection of an apparently solitary metastasis
When the grade of a unresectable tumor remains in doubt after biopsy
Differentiation of suspected tumor from radiation or surgical fibrosis
Determination of response to therapy
Gastrointestinal stromal tumor for initial staging and re-staging when there is documented recurrence

Exclusionary Guidelines

When used in evaluation of soft tissue sarcoma, including, but not limited to, the following applications:

Distinguishing between benign lesions and malignant soft tissue sarcoma
Distinguishing between low grade and high grade soft tissue sarcoma
Detecting locoregional recurrence
Detecting distant metastasis

Testicular cancer
Inclusionary Guidelines

For initial treatment strategy when testicular cancer is strongly suspected based on other diagnostic testing and imaging results are required to determine treatment options

Exclusionary Guidelines

All other indications.

Thyroid cancer
Inclusionary Guidelines

For the initial treatment strategy of thyroid cancer types known not to concentrate radioactive iodine
For subsequent treatment strategy for differentiated thyroid cancer of follicular cell origin, which is known to concentrate radioactive iodine in the following situations:

When done following prior treatment with thyroidectomy and radioiodine ablation and
With a current serum thyroglobulin > 10 ng/ml (except in the setting of documented anti-thyroglobulin antibodies,) and
With a negative whole body RAI scan in the past

Exclusionary Guidelines

For the evaluation of known or suspected differentiated or poorly differentiated thyroid cancer in all other situations

Cancer Surveillance
Inclusionary Guidelines

Not applicable

Exclusionary Guidelines

When used as a surveillance tool for patients with cancer or with a history of cancer. A scan is considered surveillance if performed more than six months after completion of cancer therapy (12 months for lymphoma) in patients without objective signs or symptoms suggestive of cancer recurrence

Other Oncologic Applications
Inclusionary Guidelines

Not applicable

Exclusionary Guidelines

Other oncologic applications of PET scanning are considered experimental, including, but not limited to:

Staging inguinal lymph nodes in patients with squamous cell carcinoma of the penis.

Established
82172, 86141

Experimental
82610, 83695, 83701, 83704, 83880

Basic Benefit and Medical Policy
The safety and effectiveness of measuring apolipoprotein B have been established. It may be a useful diagnostic option when indicated for individuals at intermediate or high- risk for a cardiovascular event.

The safety and effectiveness of high sensitivity C-reactive protein measurement have been established. It may be a useful diagnostic option when indicated for individuals at intermediate-risk for a cardiovascular event.

The peer-reviewed medical literature has not demonstrated the clinical utility of laboratory testing of other novel biomarkers to assess cardiovascular risk, including, but not limited to apolipoprotein A-I, apolipoprotein E, LDL subclass, HDL subclass and lipoprotein[a]). Therefore, these services are considered experimental.

This policy is effective July 1, 2014.

Inclusionary Guidelines
Apolipoprotein B
Apolipoprotein B (apo B) measurement is established for individuals at intermediate- or high-risk for a cardiovascular event who meet the following criteria:

For individuals at intermediate risk** of CVD, those with recurrent events or a family history of premature CVD or
High-risk*** individuals with hypercholesterolemia to assess whether additional interventions are necessary when LDL-C and/or non-HDL-C goals are reached

High-sensitivity C-reactive protein
High-sensitivity C-reactive protein testing is established for individuals who meet any of the following criteria:

Individuals at intermediate risk** (5-7.5 percent risk of CVD over 10 years), in whom the physician may need additional information to guide further evaluation or therapy
For the selection of patients for statin therapy:
Men ≥ 50 years of age or women ≥ 60 years of age and
With low-density lipoprotein cholesterol < 130 mg/dL and
Not on lipid-lowering, hormone replacement or immunosuppressant therapy and
Without clinical CVD, diabetes, chronic kidney disease, severe inflammatory conditions, or contraindications to statins
In asymptomatic, intermediate-risk** men ≤ 50 years of age or women ≤ 60 years of age, measurement of hs-CRP may be reasonable for CVD risk assessment.

** Intermediate-risk persons are defined as those with 5-7.5 percent 10-year atherosclerotic cardiovascular disease event risk. Refer to any of these web-based calculators:

*** High-risk persons are those with one or more of the following:

Clinically established coronary heart disease
Cerebrovascular disease
Peripheral arterial disease
Abdominal aortic aneurysm
Diabetes mellitus
Chronic kidney disease
10-year predicted ASCVD risk ≥7.5 percent

Exclusionary Guidelines

The routine measurement of apolipoprotein B in low-risk individuals (< 5 percent 10 year CV event risk) is not recommended.
Measurement of apolipoprotein B is excluded for all other indications.
hs-CRP testing is excluded for all other indications, including use as a routine screening test for the general population and for monitoring response to therapy.
In asymptomatic, high-risk adults, measurement of CRP is not recommended for CVD risk assessment.

EXPERIMENTAL PROCEDURES

83987, 95012

Basic Benefit and Medical Policy
The clinical utility of exhaled nitric oxide and exhaled breath condensate in the diagnosis and management of pulmonary disease and respiratory manifestations of underlying clinical conditions has not been demonstrated. In addition, there is insufficient evidence that the use of these tests improves health outcomes; therefore, these tests are considered experimental.

This policy is effective July 1, 2014.

GROUP BENEFIT CHANGES

City of Lathrup Village

Effective June 1, 2014, Medicare-eligible retirees of the City of Lathrup Village will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus Blue^SM Group PPO for their medical, surgical and prescription drug benefits. The group number is 60630 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.

Faurecia USA Holdings

Faurecia USA Holdings, group number 71547, joined the Blues March 1, 2014. The group offers one PPO plan for its medical and surgical benefits, two prescription drug plans, one vision plan and one consumer-directed health plan with a health savings account.

Member ID cards will show alpha prefix AJT for PPO coverage.

Oakland Stamping

Oakland Stamping will migrate from the Blues’ Michigan Operating System to the NASCO platform under new group number 71585 on July 1, 2014. The group will offer one PPO plan with medical-surgical coverage, one prescription drug plan and one vision plan.

Member ID cards will show the following alpha prefixes:

JXP – PPO coverage
XYX – CMM

The Orlans Group

The Orlans Group, migrated from the Blues’ Michigan Operating System to the NASCO platform under new group number 71584 on May 1, 2014. The group offers one PPO plan for its medical and surgical benefits, one prescription drug plan, one dental plan and one consumer-directed health plan with a health savings account and flexible spending account.

Member ID cards will show alpha prefix HOA for PPO coverage.

Tuscola County Road Commission

Effective June 1, 2014, Medicare-eligible retirees of the Tuscola County Road Commission will have Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO plan, Medicare Plus Blue^SM Group PPO for their medical, surgical and prescription drug benefits. The group number is 60619 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.