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October 2019

Changes to reimbursement policy for board-certified behavior analysts take place Jan. 1

Effective Jan. 1, 2020, the following two reimbursement policy changes affecting board-certified behavior analysts will occur.

  1. Regarding Blue Cross Blue Shield of Michigan’s Board Certified Behavior Analyst Participation Agreement, Addendum C (Reimbursement Methodology), the payment policy will change to reflect that BCBSM will pay the lesser of the billed charge or 80% of the published maximum payment... The current methodology calls for 60% of the published maximum payment.

    According to Section 6.6 of the Participation Agreement, the provider’s signature isn’t required to make an amendment to the agreement effective. However, if the provider no longer wishes to continue his or her participation in the network because of an amendment, the provider may terminate the agreement by providing 45 days written notice to Blue Cross.

    The revised agreement will be available on Jan. 1, 2020, in the Participation chapter of the online provider manual on web-DENIS.

  2. In addition to the modification to the agreement outlined above, approved amounts for adaptive behavior assessment and treatment codes also will change Jan. 1, 2020. Revised amounts will be available for viewing on web-DENIS on Oct. 1, 2019. To find fee schedule information, go to the homepage of web-DENIS and follow these steps:
    1. Click on BCBSM Provider Publications and Resources.
    2. Click on Entire Fee Schedules and Fee Changes. (After clicking on this, you’ll be asked to accept the End User Agreement.).

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.
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