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July 2013

Bill hospital-based office visits on professional claims

As part of the Hospital Outpatient Pricing Strategy, Blue Cross Blue Shield of Michigan will no longer make separate facility payments for select office services.

BCBSM has instructed hospitals to bill hospital-based office visit services only on professional claims. An additional change is that BCBSM has made the facility and non-facility rates the same for those services.

BCBSM will pay the following evaluation and management procedure codes at the non-facility rate, regardless of setting.

E&M codes for office visits (HCPCS procedure codes):
*99201-*99205
*99211-*99215
*99381-*99387
*99391-*99397

Do not bill members for the facility portion of the visit, as the full payment will be made on the professional claim.

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 2012 American Medical Association. All rights reserved.
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