Blue Cross doesn’t reimburse providers for experimental drugs

Blue Cross Blue Shield of Michigan and Blue Care Network won’t reimburse providers for experimental drugs, effective Jan. 1, 2021. This applies to all claims submitted for Blue Cross commercial, Medicare Plus Blue℠, BCN commercial and BCN Advantage℠ members.

When you bill these types of drugs on a UB-04 for inpatient services, use the correct revenue code and modifiers for experimental drug usage. Use revenue code 0256 – experimental drugs, along with the appropriate Advance Beneficiary Notice of Noncoverage modifier (GA, GX, GY, GZ).

Health care providers may not bill members for such services unless, prior to the services, all these requirements are met:

• You provide the member with a cost estimate of the service.
• You have the member confirm in writing that he or she assumes financial responsibility for the service.

The member understands that Blue Cross won’t reimburse the provider for the service.