As previously reported in CMA Alert, Blue Cross of California recently notified physicians of changes to its Prudent Buyer fee schedule. According to a notice mailed to physicians, the insurer plans to modify payment levels for many CPT codes, some being increased and others decreased.  As you know, Blue Cross delayed implementation of its new fee schedule, originally scheduled to take effect June 1, because of outrage from CMA and the physician community over the insurer’s failure to provide physicians with timely access to the new fee schedule. The new implementation date is August 30.

CMA this week learned that Blue Cross has reconsidered some of the planned fee schedule reductions and has decided to leave some codes unchanged. Affected are some breast biopsy, breast mammography, colonoscopy, and newborn care codes.

No changes will be made to the following:

• Hospital-based newborn care (99431, 99432, 99433, 99435, 99436, 99440)
• Mammograms (77051, 77052, 77055, 77056, 77057, G0202, G0204, G0206)
• Colonoscopies (45378, 45379, 45380, 45381,45382, 45383, 45384, 45385)
• Other (19103)

Blue Cross will soon post an update on its website and each affected physician will receive a notice from the insurer. The notice will include a link to the updated fee schedule where all changes will be reflected.In the meantime, you can view new rates here. (After you log in, click on “What’s New” then “Request Pricing.”)

Physicians are urged to calculate the impact of the fee schedule changes on their practices before it takes effect August 30. You should also be aware that you have the right to terminate an agreement if any “material change” to the contract terms is not acceptable to your practice.

CMA has published a Blue Cross of California Survival Kit to help you assess the impact fee schedule changes would have on your practice based on your most commonly billed CPT codes. The tool kit, available free to CMA members, answers frequently asked questions and discusses the options for physicians who determine that the new contract terms would negatively impact their practices.

CMA’s Reimbursement Help Line, 888/401-5911 gfonseca@cmanet.org.