February 20, 2020
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
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.
||Psychiatric diagnostic evaluation without medical services
||Psychiatric diagnostic evaluation with medical services
||Psychotherapy, 30 minutes with patient and/or family member
||Psychotherapy, 30 minutes (billed with E/M code)
||Psychotherapy, 45 minutes with patient and/or family member
||Psychotherapy, 45 minutes (billed with E/M code)
||Psychotherapy, 60 minutes with patient and/or family member
||Psychotherapy, 60 minutes (billed with E/M code)
||Psychotherapy for crisis; first 60 minutes
||Psychotherapy for crisis; each additional 30 minutes
||Family psychotherapy (without the patient present) 50 minutes
||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.