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Annual Fee Schedule Update Notification

Posted February 24, 2016

Effective June 1, 2016, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement its annual update of the Schedule of Maximum Allowances (SMA) for durable medical equipment (DME) supplies, prosthetics, orthotics and clinical laboratory codes. Updates will also be made to the National Drug Code (NDC) fee schedule and home infusion administration codes at the same time. The changes to the fee schedules take into consideration the revisions made by the Centers for Medicare & Medicaid Services to the resource based relative value scale. 

Reimbursement for services provided on or after June 1, 2016, will be based on the updated fee schedule. This update affects PPO and Blue Choice PPOSM fee schedules for professional providers. Providers may request fee schedules for this update starting May 25, 2016. 

The information above is not intended to be an exhaustive listing of all the changes. Annual and quarterly fee schedule updates may be requested by using the appropriate Fee Schedule Request Form, available in the Education and Reference Center/Forms section. This form also may be used to request updates on specific code changes that are referenced in the Blue Review.