What facilities need to know about proposed new policy for multiple therapy services and how to provide input

Blue Cross Blue Shield of Michigan is proposing implementation of a new payment reduction policy for physical, occupational and speech therapy. Program implementation is scheduled for the fourth quarter of 2022 for Blue Cross commercial members.

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. This change is being made to align with the Centers for Medicare & Medicaid Services’ Multiple Therapy Policy.

The policy doesn’t interfere with benefit limits. Blue Cross allows 90 therapy visits per calendar year, and these rules won’t affect those limits.

What this means to facilities

When multiple therapy services are rendered on the same day, we’ll apply a “therapy pay percent edit.” The primary service will be reimbursed at 100% of the allowed amount, while secondary procedures performed on the same day will be reduced by 50% of the practice expense relative value unit, or RVU.

The service with the highest 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 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.

The top five procedure codes that would receive the facility edit (reduced payment) include:

• *97140 – MANUAL THERAPY 1/> REGIONS
• *97110 – THERAPEUTIC EXERCISES
• *97530 – THERAPEUTIC ACTIVITIES
• *97112 – NEUROMUSCULAR REEDUCATION
• *97116 – GAIT TRAINING THERAPY

Input requested

According to the Contract Administration Process — part of the Participating Hospital Agreement that went into effect July 1, 2021 — we allow non-binding input from participating facilities about such proposals.
Input from facilities is requested by July 31, 2022. Send any input you may have to Liz Bowman at ebowman@bcbsm.com.

After input is received, Blue Cross has 30 calendar days to respond.