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April 2017

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, 2017. 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 2017 Medicare resource-based relative value scale for most relative value unit-priced procedures for dates of service on and after July 1. Most fees are currently priced using the 2016 values.

At the same time, the conversion factor used to calculate anesthesia base units for anesthesia procedures will increase to $58.65 throughout Michigan. Also effective July 1, the percentage weight for the QK or QY modifier will be adjusted from 56 percent to 55 percent, and the QX modifier will be adjusted from 44 percent to 45 percent.

Each year, Blue Cross adjusts its fee schedule to add the equivalent of 1.5 percent to support an increase in Value-Based Reimbursement. This is a continuation of the approach we have taken in the past, as we transition from a pure fee-for-service payment model to one where the fees reflect the delivery of the service and the overall value of services delivered to the patient.

Fee schedules effective July 1 will be available on web-DENIS on April 1. To find fee schedule information on web-DENIS:

  • Click the Provider Publications and Resources page.
  • Click on Entire Fee Schedules and Fee Changes.

Only claims submitted with dates of service on or after July 1 will be reimbursed at the new rates.

Note: Physician Group Incentive Program allocation 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 2016 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.