Blue Shield announces fee schedule changes effective December 1

September 24, 2013

Blue Shield announced changes to its physician fee schedule that will take 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 will be available on the Blue Shield website (under Helpful Resources) beginning October 1. 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. 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, the California Medical Association (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.

Contact: Reimbursement Helpline, (888) 401-5911 or economicservices@cmadocs.org.


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