The Record - Blues highlight medical, benefit policy changes

Billing chart: 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

UPDATES TO PAYABLE PROCEDURES

ADD: 83037, 86803, 87077, G0433

DELETE: 82042, 83518, 83520, 84157, 86703

Basic benefit and medical policy

Physician Office Laboratory List updates

Procedure codes 83037, 86803, 87077 and G0433 are payable in the physician’s office location. These procedure codes have been added to the Physician Office Laboratory List, effective Jan. 1, 2015.

Procedure codes 82042, 83518, 83520, 84157 and 86703 are no longer payable in the physician’s office location, effective March 1, 2015. These procedures will be removed from the Physician Office Laboratory List. The procedure must be submitted to an independent laboratory for reimbursement, effective March 1, 2015.

G0452, 81479

Basic benefit and medical policy

Genetic testing for CHEK2 mutations for breast cancer

Genetic testing for CHEK2 mutations in patients with breast cancer or for cancer risk assessment in patients with or without a family history of breast cancer is experimental. It hasn’t been scientifically demonstrated to improve patient clinical outcomes.

This policy is effective Jan. 1, 2016.

J3490, J3590

Basic benefit and medical policy

Kanuma™ added to Specialty Pharmacy Prior Authorization program

Kanuma™ was added to the Specialty Pharmacy Prior Authorization program effective Feb. 1, 2016, under the non-specific procedure codes J3490 and J3590.

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.