Blue Cross introducing payment policy for multiple therapy services

Starting in October, Blue Cross Blue Shield of Michigan will use a new payment reduction procedure for physical, occupational and speech therapy.

This policy will reduce reimbursement for the practice expense portions of therapy procedures when those services are the secondary or subsequent procedures provided on a single date of service by the same physician or other qualified health care professional. The change is being made to align with the Centers for Medicare & Medicaid Services’ Multiple Therapy Policy.

The service with the highest Relative Value Unit, or RVU, is considered the primary service. The practice expense RVU includes the nonphysician clinical and nonclinical labor of the practice, as well as expenses for building space, equipment and office supplies. Such expenses are considered duplicative for each subsequent therapy service and therefore will be reduced by 50% accordingly.

This practice expense reduction will result in an approximate average reimbursement of 83% of the allowed amount for all subsequent therapy services rendered on the same day.  

In the Facility section of this issue of the newsletter, we provide details on how facilities can provide input on this new procedure.