CMA has recently received some clarification from Blue Shield on its new multiple services payment policy, which takes effect July 1.

In a letter to physicians last month, the insurer announced a new multiple services payment policy, which will in some circumstances reduce reimbursement for multiple procedures provided on the same day. CMA asked Blue Shield to provide physicians with details on the codes affected by this new policy and the amount of the fee reductions. According to Blue Shield, the CPT codes impacted by this new policy are 97001 to 97840. There will be three payment tiers (with the first tier being paid at 100 percent). The actual amount of the fee reductions for second and third tiers will soon be available on Blue Shield’s secure provider website.

Included with the letter was a “provider allowance review” form to be used to request reimbursement amounts by CPT code. CMA expressed concern that the 20-day turnaround for fee schedule requests would make it difficult for most physicians to obtain this information prior to the July 1 effective date. According to Blue Shield, the 20-day turnaround mentioned in its letter was a typographical error. The actual turnaround time is 10 or fewer business days.

CMA has also created a financial impact worksheet to help physicians assess the impact fee schedule changes will have on their practices based on their most commonly billed CPT codes.

Contact: CMA’s Reimbursement Help Line, 888/401-5911 or jblack@cmanet.org.