Blue Shield of California announces fee schedule changes for some services

February 20, 2020
Area(s) of Interest: Practice Management Payor Issues and Reimbursement 

Blue Shield of California has announced upcoming changes to its physician fee schedule that will take effect on April 15, 2020. In a February 6 notice sent to physicians, the plan advised that it will be implementing fee schedule changes for durable medical equipment and clinical services.

Following the distribution of the notice, the California Medical Association (CMA) received a few calls from physicians about the scope services included as “clinical services.” CMA reached out to Blue Shield to obtain clarification and the plan shared that “clinical services” refers to clinical laboratory services billed for by physicians. Blue Shield also clarified that there are no changes to reimbursement for professional services such as E/M codes, surgeries, procedures or pathology services.

In a separate February 6 notice to providers, Blue Shield also advised that it will increase reimbursement for the following behavioral health codes.

CPT Code  Description
90791 Psychiatric diagnostic evaluation without medical services
90792 Psychiatric diagnostic evaluation with medical services
90832 Psychotherapy, 30 minutes with patient and/or family member
90833 Psychotherapy, 30 minutes (billed with E/M code)
90834 Psychotherapy, 45 minutes with patient and/or family member
90836 Psychotherapy, 45 minutes (billed with E/M code)
90837 Psychotherapy, 60 minutes with patient and/or family member
90838 Psychotherapy, 60 minutes (billed with E/M code)
90839 Psychotherapy for crisis; first 60 minutes
90840 Psychotherapy for crisis; each additional 30 minutes
90846 Family psychotherapy (without the patient present) 50 minutes
90847 Family psychotherapy (conjoint psychotherapy) (with patient present) 50 minutes


The new rates are available on the Blue Shield website (under the "Claims” section, click “Professional Fee Schedule” then click “Search the Claims Fee Schedule”). 

Physicians can also request fee change information on up to 12 allowances per practice by completing the provider allowance review form enclosed with the notice and e-mailing it to BSCProviderInfo@blueshieldca.com. Providers with questions can contact the Blue Shield Provider Services Department at (800) 258-3091.

Contact: CMA's reimbursement helpline, (888) 401-5911 or email us.


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