The Record header image

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

We’re making chiropractic, and sleeve gastrectomy and hernia repair payment policy updates

Chiropractic: Blue Cross Blue Shield of Michigan is updating its payment policy to no longer apply a bundling edit when procedure code *98943 is billed with other specified chiropractic manipulative treatment codes. Procedure code *98943 will be eligible to receive separate reimbursement at 50% of the allowed amount when billed with *98940, *98941 and *98942. This update will apply to claims processed starting in January.

Sleeve gastrectomy and hernia repair: Starting in March 2024, Blue Cross will be updating its payment policy to apply bundling edits to internal hernia repair codes when billed with bariatric surgery codes. Hernia repair codes won’t receive separate reimbursement when billed with bariatric surgery codes as they are considered incidental or mutually exclusive to the bariatric procedure. The specified codes applicable to this policy are as follows:

  • Internal hernia repair codes: *43280, *43281, *43282, *43283
  • Bariatric surgery codes: *43770, *43771, *43772, *43773, *43774, *43775

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.