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August 2018

Pilot program promotes effective pain control through limiting post-operative opioid dispensing

Blue Cross Blue Shield of Michigan is piloting an initiative for select surgeries aimed at promoting effective pain control through care processes that limit opioid dispensing.

Effective immediately, Blue Cross’ payment policy will be modified to allow surgeons to report modifier 22 for an additional 35 percent reimbursement when pain control optimization protocols are used to support the surgery. It’s expected that each claim reporting modifier 22 will include attestation that such processes were included as part of the surgery.

This initial period of the pilot program will include the following surgical categories:

  • Laparoscopic cholecystectomy
  • Inguinal hernia repair
  • Thyroidectomy
  • Endoscopic sinus surgery and septoplasty
  • Prostatectomy
  • Bariatric surgery

To bill the modifier 22 for adherence with the pain control optimization pathway, the physician agrees to follow the recommendations of Michigan Opioid Prescribing Engagement Network, or Michigan-OPEN, as found on its prescribing recommendations website.**

The physician also agrees to the following guidelines:

  • No additional pills are prescribed after the initial discharge prescription.
  • No opioid prescriptions have been filled within 30 days before surgery, with certain exceptions.
  • For procedures with limited opioids recommended after surgery, Blue Cross will allow up to 10 percent to have an additional fill for an opioid within 30 days after surgery to accommodate unexpected excessive pain.

This pilot program is expected to last one to two years for these initial procedures, based on results. We’ll announce further details in future Record articles.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
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