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May 2020

We’re making a professional payment policy change for select procedures done in ambulatory surgical facilities

Blue Cross Blue Shield of Michigan recognizes that for certain procedures, additional effort is required and additional costs are incurred when performed outside of a hospital setting. Effective July 1, 2020, the PPO physician reimbursement policy will increase allowed amounts by 15% for select procedures when done in an ambulatory surgical facility. For a preliminary list of the CPT codes for these procedures, click here.

We’ll continue to closely monitor our list of eligible procedures and adjust it based on provider input and other factors, including the effectiveness of the policy. Any other procedures not listed will be paid at the published rate.

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 2019 American Medical Association. All rights reserved.