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January 2019
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
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| POLICY CLARIFICATIONS |
J3490 |
Basic benefit and medical policy
Aristada Initio (aripiprazole lauroxil)
Effective June 25, 2018, Aristada Initio (aripiprazole lauroxil) is covered for the following FDA-approved indications:
Aristada Initio (aripiprazole lauroxil) is used for the initiation of Aristada (aripiprazole lauroxil), a long-acting injectable atypical antipsychotic for the treatment of schizophrenia in adults. Aristada Initio is only to be used as a single dose to re-initiate Aristada treatment following a missed dose of Aristada. Aristada Initio is administered as an extended-release injectable suspension, 675 mg is provided in a single dose pre-filled syringe.
NDC: 65757050003.
Preauthorization isn't required.
This drug isn’t a benefit for URMBT. |
J3590 |
Basic benefit and medical policy
Palynziq (pegvaliase-pqpz)
Effective May 24, 2018, Palynziq (pegvaliase-pqpz) was
covered for the following FDA-approved indications:
Palynziq (pegvaliase-pqpz) is a phenylalanine-metabolizing enzyme indicated to reduce blood phenylalanine concentrations in adult patients with phenylketonuria who have uncontrolled blood phenylalanine concentrations greater than 600 micromol/L on existing management. The recommended initial dosage is 2.5 mg subcutaneously once weekly for four weeks. Titrate the dosage in a step-wise manner over at least five weeks based on tolerability to achieve a dosage of 20 mg subcutaneously once daily.
NDCs: 68135075620, 68135005890, 68135067340.
Preauthorization isn't required.
This drug isn’t a benefit for URMBT. |
| GROUP BENEFIT CHANGES |
Metro Health Hospital |
Metro Health Hospital, group number 71719, is adding a vision option.
Group number: 71719
Alpha prefix: JXP
Platform: NASCO hybrid
Plans offered:
PPO triple tier medical/surgical (no drugs)
HDHP PPO triple tier medical/surgical (CDH HSA) with drugs
New vision option on MOS platform |
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