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December 2016
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:
- Log in to web-DENIS.
- 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
|
| NEW PAYABLE PROCEDURES |
77610, 77615 |
Basic benefit and medical policy
Local, regional hyperthermia therapies
The safety and effectiveness of some local and regional hyperthermia therapies have been established. It may be considered a useful therapeutic option when used in combination with radiation therapy in specified situations.
Whole body hyperthermia therapy is considered experimental in the treatment of malignancies. The policy has been updated, effective Sept. 1, 2016.
Note: The codes 77610 and 77615 replace 77605, which has been changed to non-payable, effective Oct. 1, 2016.
Inclusions:
Local or regional hyperthermia therapy used in combination with radiation therapy for the treatment of primary or metastatic cutaneous or subcutaneous superficial tumors.
Exclusions:
- Local or regional hyperthermia when used alone or in combination with chemotherapy
- Whole body hyperthermia
|
J3490 |
Basic benefit and medical policy
Hymovis (hyaluronate, mod., non-crosslink)
Effective Sept. 9, 2015, Hymovis (hyaluronate, mod., non-crosslink) is covered for U.S. Food and Drug Administration-approved indications. Hymovis (hyaluronate, mod., non-crosslink) should be reported with J3490, until a permanent code is established. Pharmacy doesn’t require preauthorization for this drug. |
J7199 |
Basic benefit and medical policy
Vonvendi (von Willebrand) recombinant
Effective Dec. 8, 2015, Vonvendi (von Willebrand) recombinant is covered for FDA-approved indications for on-demand treatment and control of bleeding episodes in adults. Vonvendi (von Willebrand) recombinant should be reported with J7199, until a permanent code is established. Pharmacy doesn’t require preauthorization for this drug. |
| UPDATES TO PAYABLE PROCEDURES |
81200-81408, 81479, 88271, 88272, 88273, 88274, 88275, 89290, 89291 |
Basic benefit and medical policy
Genetic testing – pre-implantation
The genetic testing – pre-implantation policy has been updated. This policy is effective Sept. 1, 2016.
Pre-implantation genetic diagnosis, or PGD, may be considered established as an adjunct to in vitro fertilization in couples with the IVF benefit meeting specific criteria.
Pre-implantation genetic screening, or PGS, as an adjunct to IVF is considered experimental in patients or couples who are undergoing IVF in all situations. The effective date is Sept. 1, 2016.
Members or couples who aren’t known to be infertile should check benefit coverage documentation to determine if pre-implantation genetic testing as an adjunct to IVF is a covered benefit. The effective date is Sept. 1, 2016.
Inclusions:
Must have the IVF benefit and meet one of the following criteria:
- For evaluation of an embryo at an identified elevated risk of a genetic disorder such as when:
- Both partners are known carriers of a single gene autosomal recessive disorder
- One partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring who has been diagnosed with that recessive disorder
- One partner is a known carrier of a single gene autosomal dominant disorder
- One partner is a known carrier of a single X-linked disorder
- For evaluation of an embryo at an identified elevated risk of structural chromosomal abnormality such as for:
- A parent with balanced or unbalanced chromosomal translocation
Exclusions:
All other situations than those specified above.
Policy guidelines
In some cases involving a single X-linked disorder, determination of the sex of the embryo provides sufficient information for excluding or confirming the disorder.
The severity of the genetic disorder is also a consideration. At the present time, many cases of pre-implantation genetic diagnosis, or PGD, have involved lethal or severely disabling conditions with limited treatment opportunities, such as Huntington chorea or Tay-Sachs disease. Cystic fibrosis is another condition for which PGD has been frequently performed. However, cystic fibrosis has a variable presentation and can be treatable. The range of genetic testing that is performed on amniocentesis samples as a possible indication for elective abortion may serve as a guide.
This policy doesn’t attempt to address the many ethical issues associated with pre-implantation genetic testing, or PGT, that, it’s hoped, have involved careful discussion between the treated couple and the doctor. For some couples, the decision may involve the choice between the risks of an IVF procedure and deselection of embryos as part of the PGT treatment versus normal conception with the prospect of amniocentesis and an elective abortion. |
| POLICY CLARIFICATIONS |
E1399 |
Basic benefit and medical policy
Vitrectomy face support system
Blue Cross Blue Shield of Michigan considers the vitrectomy face support system medically necessary for patients who have undergone vitrectomy surgery and who are required to maintain a facedown position post surgery.
The rental of a vitrectomy face support may be medically necessary for up to six weeks after vitrectomy surgery. Coverage of vitrectomy face support systems are provided through rental only.
This policy is effective May 1, 2016. |
| GROUP BENEFIT CHANGES |
Amcor Rigid Plastics |
Amcor Rigid Plastics, group number 71737, will join Blue Cross Blue Shield of Michigan, effective Jan. 1, 2017.
Group number: 71737
Alpha prefix: PPO (KOR)
Platform: NASCO
Plans offered:
PPO, medical/surgical
Hearing
CDH – HSA |
Amcor Tobacco |
Amcor Tobacco, group number 71741, will join Blue Cross Blue Shield of Michigan, effective Jan. 1, 2017.
Group number: 71741
Alpha prefix: PPO (KOR)
Platform: NASCO
Plans offered:
PPO, medical/surgical
Hearing
CDH – HSA |
Amcor Flexibles |
Amcor Flexibles, group number 71742, will join Blue Cross Blue Shield of Michigan, effective Jan. 1, 2017.
Group number: 71742
Alpha prefix: PPO (KOR)
Platform: NASCO
Plans offered:
PPO, medical/surgical
Hearing
CDH – HSA |
Barnes Group |
Barnes Group, group number 72726, will join Blue Cross Blue Shield of Michigan, effective Jan. 1, 2017.
Group number: 72726
Alpha prefix: BGC
Platform: NASCO
Plans offered:
PPO, medical/surgical
Dental
Prescription drugs
CDH – HSA |
Chemical Financial Corporation |
Chemical Financial Corporation (formally Talmer Bank and Trust), group number 71569, is switching platforms, effective Jan. 1, 2017. There will be an additional 1,300 contracts.
Group number: 71569
Alpha prefix: PPO (TBA)
Platform transition: From MOS to NASCO
Plans offered:
PPO, medical/surgical
CDH - HSA
Prescription drugs
Hearing |
Cooper Standard Automotive |
Cooper Standard will implement four new GlidePath medical plan designs, effective Jan. 1, 2017:
- PPO Basic with full purpose flexible spending account and dependent care FSA
- PPO Plus with full purpose FSA and dependent care FSA
- Consumer Choice HSA Basic with limited purpose FSA and dependent care FSA
- Consumer Choice HSA Plus with limited purpose FSA and dependent care FSA
The current dental and hearing plans for actives will be maintained, but will be renamed. The current dental, vision and hearing plans for Gaylord Retirees will be maintained.
Group number: 71404
Alpha prefixes: TDJ – Traditional
TDQ – Comp
TDV – PPO
Platform: NASCO |
Durr Systems, Inc. |
Durr Systems, Inc. is adding a new division, Stiles Machinery, effective Jan. 1, 2017.
Group number: 71484
Alpha prefix: PPO DUY
Platform: NASCO
Plans offered:
Two PPO, one HDHP HSA, medical/surgical
Prescription |
Electrical Workers Insurance Fund |
Electrical Workers Insurance Fund, group number 71738, is joining Blue Cross Blue Shield of Michigan, effective Jan. 1, 2017.
Group number: 71738
Alpha prefix: PPO (EWI)
Platform: NASCO
Plan offered:
PPO plan, medical/surgical |
General Dynamics Land Systems |
General Dynamics Land Systems, group number 71717, is switching platforms, effective Jan. 1, 2017.
Group number: 71717
Alpha prefixes: PPO (DYM)
Medicare PPO (GDN)
Platform migration: From MOS to NASCO
Plans offered:
PPO, medical/surgical
Prescription drugs
HSA
Hearing |
Hemlock Semiconductor Corporation |
Hemlock Semiconductor Corporation will be moving membership from Dow Corning to Hemlock Semiconductor Corporation, effective Jan. 1, 2017.
Group number: 71745
Alpha prefixes: PPO-JXP
Platform: NASCO
Plans offered:
1 PPO, medical/surgical
Prescription drugs |
Meadowbrook, Inc. |
Meadowbrook, Inc., group number 71721, will join Blue Cross Blue Shield of Michigan, effective Jan. 1, 2017.
Group number: 71721
Alpha prefix: MBI
Platform: NASCO
Plans offered:
PPO, medical/surgical
Dental
Prescription drugs
Vision (VSP)
CDH -HSA and FSA |
PulteGroup |
PulteGroup, group number 71458, will join Blue Cross Blue Shield of Michigan, effective Jan. 1, 2017.
Group number: 71458
Alpha prefixes: PPO
EPO (PUU)
Platform: NASCO
Active, Cobra
Plans offered:
EPO
Consumer Driven Health Option
HSA HPHP PPO with prescription drugs |
NGK Spark Plugs (U.S.A.), Inc. |
NGK Spark Plugs (U.S.A.), Inc., group number 71746, will join Blue Cross Blue Shield of Michigan, effective Jan. 1, 2017.
Group number: 71746
Alpha prefixes: PPO (NGR)
EPO (NGR)
Platform: NASCO
Plans offered:
PPO, medical/surgical
Prescription drugs
Hearing |
SpartanNash Company |
SpartanNash Company is adding an additional health saving account plan, effective Jan. 1 2017.
Group number: 71575
Alpha prefix: NSS
Platform: NASCO
Plans offered:
Medical/surgical: Two HDHP/HSA and one PPO
Prescription drugs
Hearing |
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