The Record header image

Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article
December 2023

Update: We’ve added extended fees for some external peer reviews

As previously communicated in a September 2023 Record article, we recently increased the cost for external reviews. The base cost of a standard clinical review is $378 per review. The base cost of a coding review is $334.

Extended fees will apply to the scenarios listed below and billed at the base rate plus $125 each hour after.

  • Documentation exceeding 2,000 pages
  • Diagnoses greater than or equal to three codes

According to Blue Cross Blue Shield of Michigan and Blue Care Network participation agreements with health care providers, the facility or practitioner’s office is responsible for paying the total cost of the appeal review if the peer review agency upholds Blue Cross’ decision regarding a claim.

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 2022 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.