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April 2016

Blue Cross changing practitioner fees July 1

Blue Cross Blue Shield of Michigan will change practitioner fees, effective with dates of service on or after July 1, 2016. This change applies to services provided to our Traditional, TRUST, Blue Preferred PlusSM and Blue Cross® Metro Detroit EPO members, regardless of customer group.

Blue Cross will use the 2016 Medicare resource-based relative value scale for all relative value unit-priced procedures for dates of service on and after July 1. Most fees are currently priced using the 2015 values.

Changes in resource-based relative values can affect fees. Procedure code maximum fees will increase or decrease based on the new relative value units and Blue Cross’ conversion factors.

At the same time, the conversion factor used to calculate anesthesia base units for anesthesia procedures will increase and be aligned at $58 throughout Michigan. Also effective July 1, the percentage weight for the QK or QY modifier will be adjusted from 60 percent to 56 percent, and the QX modifier will be adjusted from 40 percent to 44 percent.

We conducted a comprehensive analysis of professional provider performance and current economic indicators annually to calculate practitioner fees, with consideration for corporate and customer cost concerns. Blue Cross remains committed to reviewing professional provider performance to determine the need for increases or decreases in our maximum payments.

Fee schedules effective July 1 will be available on web-DENIS on April 1. Click on Entire Fee Schedules and Fee Changes on the web-DENIS BCBSM Provider Publications and Resources page to find fee information. Only claims submitted with dates of service on or after July 1 will be reimbursed at the new rates.

Please note that the Physician Group Incentive Program allocation (formerly known as the physician organization component) of professional fees remain the same this year.

For more information, contact your provider consultant.

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 2015 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.