Blue Cross, BCN to begin reimbursing E/M when billed with preventive service

Blue Cross Blue Shield of Michigan and Blue Care Network will begin reimbursing for evaluation and management, or E/M, services at 50% of the allowed amount when billed on the same day as a preventive service. (See list below.) The preventive service will pay in full. This is a change from Blue Cross and BCN’s current policy that only pays for the preventive service. 

When two services are done on the same day, the modifier 25 must be billed with the E/M code or it won’t be paid.  

This reimbursement change will be effective for dates of service beginning June 1, 2024. If a denial occurs while the claim system is being updated, resubmit your claim after the update is complete. The update is expected to be completed in late June. Do not submit an appeal for dates of service after June 1.

E/M codes reimbursed at 50%:

*99201–*99205
*99211–*99215
*99341–*99345
*99347–*99350

Preventive codes:

*99381–*99387
*99391–*99397
*99401–*99404
*99406–*99409
*99411–*99412
S0610
S0612–S0613