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December 2016

In February 2017, we’re discontinuing VBR for J-code oncology subset

Providers taking part in the Physician Group Incentive Program’s Michigan Oncology Clinical Treatment Pathways Collaborative were eligible to receive value-based reimbursement for a subset of J-codes for oncology drugs.

The Pathways program was retired June 30, 2016. Therefore, starting Feb. 28, 2017, Blue Cross Blue Shield of Michigan will discontinue providing value-based reimbursement for the subset of J-codes. Blue Cross will continue to pay value-based reimbursement for these subset J-codes to all former Pathways participants until Feb. 28.

These are the J-codes that will no longer be eligible for value-based reimbursement.

HCPCS code

Drug name

J0640

CA LEUCOVORIN, 50 MG

J1626

GRANISETRON HCL (generic KYTRIL), 100 MCG

J2405

ONDANSETRON HCL (generic ZOFRAN), 1MG

J2430

PAMIDRONATE DISODIUM (generic AREDIA), 30 MG

J9000

DOXORUBICIN (generic ADRIAMYCIN), 10 MG

J9045

CARBOPLATIN, 50 MG

J9060

CISPLATIN, 10 MG

J9100

CYTARABINE, 100 MG

J9178

EPIRUBICIN (generic ELLENCE), 2 MG

J9181

ETOPOSIDE (generic TOPOSAR), 10 MG

J9190

FLUOROURACIL, 500 MG

J9206

IRINOTECAN (generic CAMPTOSAR), 20 MG

J9208

IFOSFAMIDE (generic IFEX), 1 GM

J9267

PACLITAXEL (generic TAXOL), 1MG

J9293

MITOXANTRONE (generic NOVANTRONE), 5 MG

J9370

VINCRISTINE, 1 MG

J9390

VINORELBINE (generic NAVELBINE), 10 MG

We remain committed to the development of an incentive model for oncologists for their efforts in improving cancer care for patients. Over the next year, Blue Cross will be working with our partners in the Michigan Oncology Quality Consortium collaborative to design and implement a modernized oncology value-based reimbursement that takes into account participation in quality initiatives and patient outcome measures. Our goal is to have a new oncology value-based reimbursement model in place by March 1, 2018.

We value the importance of our oncology community and strive to provide quality oncology care for all Michigan residents. We appreciate your patience and continued support as we work with together with our provider partners to develop an oncology program that brings value to the provider community and its patients.

If you have questions, email Marc Cohen, manager, Value Partnerships, at CQIprograms@bcbsm.com.

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.
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