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Blue Shield announces temporary increases to professional fee schedule

August 11, 2020
Area(s) of Interest: Payor Issues and Reimbursement 


In an August 5, 2020, notice to providers, Blue Shield announced it would be temporarily increasing reimbursement rates for certain Evaluation and Management services to help reduce the negative impacts to practices as a result of the COVID-19 pandemic.

The increased reimbursement rates, which will reflect a flat 5% fee schedule increase, will apply to providers on the Blue Shield standard fee schedule and will be effective for dates of service from August 24 to December 31, 2020, for the following services:

CPT Code

Description

99201 – 99205 

Office visit – new patient

99211 – 99215 

Office visit – existing patient

99241 – 99245 

Office consultation

99381 – 99387 

Initial preventive medicine visit – new patient

99391 – 99397 

Periodic preventive medicine visit – established patient

99441 – 99443 

Physician/qualified health professional telephone evaluation.

99421 – 99423 

Online digital evaluation and management services for established patient

99446 – 99449 

Interprofessional phone/internet assessment and management service

 

The new rates are available on the Blue Shield website (log in then select “Professional Fee Schedule” under the Claims section of the menu). You can search for the above listed temporary rates by CPT code with a date of service on or after August 24, 2020. 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 Information and Enrollment Department at (800) 258-3091.

The COVID-19 pandemic has created an unprecedented threat to the viability of physician practices. The California Medical Association (CMA) has called on state lawmakers to ensure that health plans and insurance companies do their part to maintain our health care infrastructure, and to ensure we emerge from the COVID-19 crisis with a health care system that can meet patients’ needs. CMA appreciates that Blue Shield is taking independent steps to assist primary care physicians during this difficult time.

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

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