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December 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 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
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| NEW PAYABLE PROCEDURES |
A6550, A7000, E2402, G0456, G0457, K0743, K0744, K0745, K0746, 97605, 97606 |
Basic Benefit Policy
The safety and effectiveness of powered and non-powered (mechanical) vacuum-assisted closure, also known as negative pressure wound therapy, have been established. They may be considered useful therapeutic options to promote the healing of acute or chronic wounds that are refractory to standard therapy. This policy is effective retroactive to Jan. 1, 2013.
All auto groups and the UAW Retiree Medical Benefits Trust are excluded from this policy. |
| UPDATES TO PAYABLE PROCEDURES |
11981-11983, 57160, 57170, 58300, 58301, 90460, 90461, 90471-90474, 96372, A4261, A4266, J7300-J7302, J7307
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Basic Benefit Policy
Effective Jan. 1, 2015, certified nurse midwives will be payable providers for procedure codes A4261, A4266, J7300, J7301, J7302, J7307, 11981, 11982, 11983, 57160, 57170, 58300, 58301, 90460, 90461, 90471, 90472, 90473, 90474, and 96372. |
Equipment:
E0424, E0425, E0430, E0431, E0433-E0435, E0439-E0446, E1390-E1392, E1405, E1406, K0738
Accessories:
A4575, A4606, A4608, A4615-A4617, A4619, A4620, A7525, A9900, E0455, E0555, E0580, E1353-E1358 |
Basic Benefit Policy
Home oxygen equipment and related supplies are established as clinically safe and effective procedures. They may be considered useful therapeutic options when indicated, effective Jan. 1, 2015.
BCBSM will align our Home Oxygen Equipment and Related Supplies medical policy with Medicare's criteria, with the exception of the 36-month rental limit. We will continue to review this policy and will update you with any changes. |
| POLICY CLARIFICATIONS |
77424, 77425, 77469 |
Basic Benefit Policy
The criteria for the Intraoperative Radiation Therapy policy have been updated. This policy is effective Jan. 1, 2014.
Inclusionary Guidelines
Established for the following recurrent or unresectable cancers without distant metastases, based on NCCN guidelines:
- Abdominal and retroperitoneal sarcoma — For surgery with or without IORT as primary treatment for tumors other than gastrointestinal stromal tumors and desmoid sarcomas, provided that frozen section pathology can confidently demonstrate a non-GIST or non-desmoid pathology
- Central pelvic recurrent cervical cancer — After radiation therapy for pelvic exenteration with or without IORT
- Colon cancer — For patients with T4 or recurrent cancers as an additional boost
- Gynecological cancers — Including recurrent cervical cancer, recurrent endometrial cancer and uterine sarcomas
- Pancreatic cancer — Unresectable or resectable cases in which resection may result in close or involved margins
- Rectal cancer — For patients with T4 or recurrent cancers with very close or positive margins after resection, as an additional boost
- Recurrent uterine endometrial adenocarcinoma — In patients previously treated with external beam radiation at the site of recurrence
- Soft tissue sarcomas
Exclusionary Guidelines
These procedures are considered experimental for all other indications. |
| NATIONAL UNIFORM BILLING COMMITTEE UPDATES |
Revenue code 0953 |
Benefit Policy
The National Uniform Billing Committee approved revenue code 0953, effective Oct. 1, 2013. Although approved, this revenue code is not payable to Michigan providers and will reject when billed. |
| GROUP BENEFIT CHANGES |
Benteler |
Benteler, group number 71590, will join the Blues Jan. 1, 2015.
The group will offer three PPO plans with medical and surgical coverage, four prescription drug plans, one consumer-directed health plan and a health savings account.
Member ID cards will show alpha prefix BEE. |
Bronson Healthcare Group Inc.
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Bronson Healthcare Group Inc. members will have a new group number, effective Jan. 1, 2015: group number 71701. Bronson’s benefit plans will move to the NASCO FlexLink claims processing system. Bronson Healthcare Group Inc members will receive new ID cards that show alpha prefix BBY. You may refer to the provider telephone numbers listed on the back of the ID card. |
| Freudenberg North America LP |
Freudenberg North America, LP, group number 71700, is adding new members to its Blues coverage and moving existing Chem-Trends members to the NASCO claims system under the Freudenberg North America group.
The group offers six PPO plans with medical-surgical coverage, six prescription drug plans, one hearing care plan and six consumer-directed health plans with health savings accounts.
Member ID cards will show the following alpha prefixes:
- PPO coverage — FND
- Medicare coverage — XYX
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Daifuku Webb
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Daifuku Webb Health Care Plan is transitioning its vision coverage to a freestanding vision plan, effective Jan. 1, 2015. The new group number is 71599.
Medical, prescription drug and hearing care plans remain under the existing group number, 71507.
Member ID cards will show alpha prefix NSD. |
La-Z-Boy Inc. |
La-Z-Boy Inc., group number 71595, will join the Blues Jan. 1, 2015. The group will offer two PPO plans with medical-surgical coverage, one hearing care plan and a consumer-directed health plan with a health savings account.
Member ID cards will show alpha prefix LAB. |
Michigan Healthcare Professionals
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Michigan Healthcare Professionals, group number 71589, will move to the NASCO claims processing system Jan. 1, 2015. The group offers four PPO plans with medical-surgical coverage, one Traditional Comprehensive Master Medical plan with medical-surgical coverage, four prescription drug plans and two consumer-directed health plans with health savings accounts (basic and enhanced).
Member ID cards show alpha prefix NSS. |
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