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April 2020
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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| UPDATES TO PAYABLE PROCEDURES |
J9035
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Basic benefit and medical policy
Avastin® (bevacizumab)
Payable diagnoses for Avastin® (bevacizumab) have been updated. Diagnosis C17.0 and C71.9 have been added as payable for Avastin (bevacizumab).
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| POLICY CLARIFICATIONS |
J3490
J3590
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Basic benefit and medical policy
Enhertu (Fam-trastuzumab deruxtecan-nxki)
Effective Dec. 20, 2019, Enhertu (Fam-trastuzumab deruxtecan-nxki) is considered established for the treatment of adult patients with unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting.
This indication is approved under accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.
This service isn’t a covered benefit for URMBT. |
J9035
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Basic benefit and medical policy
Bevacizumab (Avastin®)
Bevacizumab (Avastin®), HCPCS code J9035, is approved for the treatment of vulvar cancer (ICD-10 — C51.0, C51.1, C51.2, C51.8, C51.9) effective Feb. 1, 2019. The above ICD-10 diagnosis codes are payable in addition to those diagnosis already payable.
This is not a benefit for FEP and URMBT.
These diagnosis updates apply to all professional claims and to all facility claims, excluding inpatient. |
| GROUP BENEFIT CHANGES |
Rock Central LLC |
Effective March 9, 2020, the name of group number 71544 is changing from Quicken Loans Inc. to Rock Central LLC.
Rock Central LLC
Group number: 71544
Alpha prefix: PPO (IQU)
Platform: NASCO
Plans offered:
PPO, medical/surgical
CDH — HSA, FSA
Prescription drug plans
Hearing plans |
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