Acupuncturists invited to apply to be part of Blue Cross’ provider networks

Acupuncturists have the opportunity to participate in Blue Cross Blue Shield of Michigan’s Traditional and TRUST PPO networks, Medicare Plus Blue℠, BCN commercial and BCN Advantage℠, effective March 1, 2022.

How to join a Blue Cross network

Acupuncturists can find enrollment forms and practitioner agreements at bcbsm.com/providers, starting Dec. 1, 2021. To find enrollment information, click on Enroll to become a network provider. Specific qualification requirements are identified within each agreement.

All applicants must pass a credentialing review before participation. We’ll notify applicants in writing of their approval status.

Billing for services

Participating acupuncturists can bill their professional services using codes *97810, *97811, *97813 and *97814. They can receive direct reimbursement for covered services within the scope of their licensure at 85% of the applicable fee schedule, minus any member deductibles and copayments. 

This change, effective for outpatient services provided on or after March. 1, applies to Blue Cross and BCN benefit plans that cover services these providers are licensed to provide. To find out if a member has coverage, check web-DENIS for member benefits and eligibility or call Provider Inquiry at 1-800-344-8525.

Prior authorization and referrals

Prior authorization isn’t required for acupuncture services for any member. For BCN commercial members who have a primary care provider who is part of a medical care group based in the East or Southeast region, their primary care provider must submit a referral for a specialist office visit. Referrals aren’t required for other members.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.