Blue Cross changing how nonpayable codes are displayed in fee schedules

As you may know, Blue Cross Blue Shield of Michigan pays for covered services based on the lower of either the billed charges or the Blue Cross-approved amount. In the past, Blue Cross hadn’t established fees for services that were considered nonpayable for our members but that may be covered for members of other Blue plans who received services in Michigan. Previously, nonpayable codes in our fee schedules were listed as “NP” in the fee columns.

Effective July 1, 2015, we’ll no longer display the nonpayable codes as “NP.” Instead, either our Blue Cross Blue Shield of Michigan fee will be listed or, in instances where a fee could not be established, the fee will be listed as “No fee.” In these instances, we’ll base our approved amount on the fee that is listed. When the fee listed is “No fee,” we’ll base our approved amount on the charged amount.

The change described above applies to the following professional fee schedules:

• Independent LAB Fee Schedule
• Traditional Fee Schedule
• TRUST PPO Fee Schedule
• Local Network (EPO) Fee Schedule
• BPP Fee Schedule
• DME/P&O Fee Schedule

Entire fee schedules and fee change schedules are available on web-DENIS. Click on BCBSM Provider Publications and Resources and then on Entire Fee Schedules and Fee Changes.

If you have any questions or need more information, contact your provider consultant.