The Record - For physicians and other health care providers to share with their office staffs Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article
June 2016

We’re changing the categorization process for physical therapy

Blue Cross Blue Shield of Michigan is changing its categorization process for physical therapy. The changes will be implemented in fall 2016 and will include physical therapy claims from Blue Cross Medicare Advantage PPO and Blue Cross commercial PPO plans. Blue Cross will also be extending the categorization to include outpatient occupational therapy services.

Physical therapists will continue to be assigned to three tiers identified as categories A, B and C. Providers will continue to have 15 days from receipt of their categorization reports to request reconsideration. The categorization will continue to be done by eviCore healthcare. Independent occupational therapists will default to Category B.

Due to the changes in the categorization process, profile reports scheduled for July 2016 will be omitted and replaced with the updated profile reports in September 2016. Going forward, profile reports will be available in October and April, instead of January and July. Notifications will go out to providers Nov. 1 and May 1.

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.