The Record

We’re adding more codes to multiple procedure reduction payment policy

Starting in December, Blue Cross Blue Shield of Michigan will add additional procedure codes to a payment policy that applies a 50% reduction when multiple procedures are performed during the same session. The multiple procedure reduction policy is based on guidelines from the Centers for Medicare & Medicaid Services and supports correct coding and payment accuracy.

Below is a list of the procedure codes that we recently added to the reduction policy. It will apply to these codes starting in December 2023.

Procedure code

Description

*11005

Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure

*11720

Debridement of nail(s) by any method(s); 1 to 5

*15002

Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children

*15004

Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children

*15040

Harvest of skin for tissue cultured skin autograft, 100 sq cm or less

*27215

Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral, for pelvic bone fracture patterns that do not disrupt the pelvic ring, includes internal fixation, when performed

*32550

Insertion of indwelling tunneled pleural catheter with cuff

*33946

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-venous

*33947

Extracorporeal membrane oxygenation/extracorporeal life support provided by physician; initiation, veno-arterial

*33949

Extracorporeal membrane oxygenation/extracorporeal life support provided by physician; daily management, each day, veno-arterial

*33968

Removal of intra-aortic balloon assist device, percutaneous

*36555

Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age

*36556

Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older

*36568

Insertion of peripherally inserted central venous catheter, without subcutaneous port or pump, without imaging guidance; younger than 5 years of age

*36569

Insertion of peripherally inserted central venous catheter, without subcutaneous port or pump, without imaging guidance; age 5 years or older

*36572

Insertion of peripherally inserted central venous catheter, without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age

*36573

*36580

Replacement, complete, of a non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access

*36584

Replacement, complete, of a peripherally inserted central venous catheter, without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement

*36625

Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); cutdown

*37188

Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy

*43752

Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)

*43753

Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (e.g., for gastrointestinal hemorrhage), including lavage if performed

*43756

Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen (e.g., bile study for crystals or afferent loop culture)

*43757

Duodenal intubation and aspiration, diagnostic, includes image guidance; collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single or double lumen tube, includes drug administration

*44705

Preparation of fecal microbiota for instillation, including assessment of donor specimen

*49185

Sclerotherapy of a fluid collection (e.g., lymphocele, cyst, or seroma), percutaneous, including contrast injection(s), sclerosant injection(s), diagnostic study, imaging guidance (e.g., ultrasound, fluoroscopy) and radiological supervision and interpretation when performed

*58300

Insert intrauterine device

*61645

Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)

*61796

Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 simple cranial lesion

*61798

Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 complex cranial lesion

G0455

Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2022 American Medical Association. All rights reserved.