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Reminder: Blue Shield fee schedule changes became effective December 1



December 11, 2013
Area(s) of Interest: Practice Management Public Payors 

Changes to the Blue Shield physician fee schedule took effect December 1, 2013. In a September 23 notice to physicians, the insurer said that it would be increasing payment for evaluation and management services for preventive care. Additionally, Blue Shield notes payment increases for the more commonly billed office visit codes 99204, 99205, 99213 and 99214.


The new rates are available on the Blue Shield website (under "Helpful Resources," click “Professional Fee Schedule” then click “Search the Claims Fee Schedule”). Though not indicated in the letter or on the website, in order to access the new fees, practices must change the default date of service on the “Search Fee Schedule” page to December 1, 2013, (effective date of the change) or later. Failure to do so will result in information on the current fee schedule rather than the new fee schedule.


Physicians can also request a copy of the new fees by completing the allowance review form enclosed with the notice, or by calling the Blue Shield Provider Services Department at (800) 258-3091.


Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts. The California Medical Association (CMA) reminds physicians that they do not have to accept substandard contracts that are not beneficial to their practice.


To help physicians understand their rights when a health plan has sent notice of a material change to a contract, CMA has published Contract Amendments: an Action Guide for Physicians, available in the CMA Store. The guide includes a discussion of options available to physicians when presented with a material change to a contract. Additionally, the guide includes a financial impact worksheet that will help physicians calculate the net impact of the fee schedule changes on their practice.

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