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December 2023

We’ve updated our chiropractic and osteopathic manipulation benefits

Blue Cross Blue Shield of Michigan has updated its chiropractic and osteopathic manipulation benefits to combine outpatient facility and professional member accumulation visit maximums and cost share. The updates were effective for all applicable groups for dates of service on and after Sept. 1, 2023.   

These changes apply to the following Blue Cross commercial groups that have chiropractic and osteopathic benefits:

  • Fully insured
  • Self-funded

When an outpatient facility and professional claim is reported in Place of Service 2 (outpatient hospital) for the same encounter on the same date of service, the accumulated service counts as only one visit toward the member’s benefit maximum. If a member receives an additional manipulation on the same date in a different POS 3 (office), the visit will be accumulated as a separate visit toward the member’s visit maximum.

Professional and facility existing group cost share won’t change. Services performed in a facility setting will apply facility cost share while services in an office setting will apply an office cost share.

Revenue code 0531 was turned on to accommodate the billing and reimbursement of osteopathic manipulations when reported with a valid CPT procedure code. This revenue code will apply fee-based reimbursement for the applicable codes.

The alignment of the benefits across both an outpatient facility and a provider’s office allows Blue Cross to adapt to the growing changes in provider billing practices. The changes will ensure compliance with benefit plan designs for our groups and will consistently apply benefit experiences regardless of where services are provided.

Note: Claims will continue to deny manipulation services when a group doesn’t have chiropractic or osteopathic benefits.

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.