Medicare Plus Blue^SM adjusts molecular lab claim reimbursement

Effective for claims with dates of service on or after March 22, 2015, Blue Cross Blue Shield of Michigan’s Medicare Plus Blue plan will reimburse providers 65 percent of the charged amount for unlisted molecular pathology claims (procedure code *81479). A Medicare remittance advice will not be required for payment.

Currently, we reimburse at 25 percent without a remittance advice and 100 percent of the Medicare fee if the claim is submitted with a remittance advice.

Supporting documentation will still be required with all related claims to determine medical appropriateness and to ensure timely processing. When the necessary documentation is not attached, claims will be denied.

Required documentation includes but may not be limited to the following:

• Patient medical records
• Physician narrative
• Diagnosis and procedure code(s)
• Lab order
• Lab results

If you have any questions, contact your provider consultant.