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Procedure Code and Fee Schedule Updates

Posted February 26, 2019

As part of our commitment to help inform our independently contracted providers of certain developments, Blue Cross and Blue Shield of Illinois (BCBSIL) has designated a specific section in the Blue Review to notify you of any significant changes to the physician fee schedules. It’s important to review this section each month. 

Effective March 1, 2019, select immunizations, vaccines and toxoids in the 90281-90396 and 90476-90756 Current Procedural Terminology (CPT®) code ranges will be updated. Please note that not all CPT codes in this range will be affected.

FEE SCHEDULE UPDATE:

Effective June 1, 2019, BCBSIL will implement its annual update of the Schedule of Maximum Allowances (SMA) including Durable Medical Equipment (DME) supplies, prosthetics, orthotics and clinical laboratory codes. This fee schedule update takes into consideration the revisions made by the Centers for Medicare & Medicaid Services (CMS) to the resource based relative value scale. Reimbursement for services provided on or after June 1, 2019, 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 24, 2019.

The information above is not intended to be an exhaustive listing of all the changes. Annual and quarterly fee schedule updates may also be requested by using the Fee Schedule Request Form. Specific code changes that are listed above may also be obtained by downloading the Fee Schedule Request Form and specifically requesting the updates on the codes listed in the Blue Review. The form is available on the Forms page.

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