Updated: CMS Payment Adjustments for Medicare and MMAI Providers During Public Health Emergency

May 21, 2021 (Updated February 15, 2022)

This notice has been updated with new information on the Medicare sequester suspension period, which has been extended through March 31, 2022.

On June 22, 2020, we mentioned that during the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) has adjusted certain payments to Medicare providers. Blue Cross and Blue Shield of Illinois (BCBSIL) is applying these temporary adjustments to claims reimbursements, as appropriate and where consistent with network contracts, for Medicare Advantage and Medicare-Medicaid Alignment Initiative (MMAI) providers. This includes providers who provide care and services to our members with any of the following plans:

  • Blue Cross Medicare Advantage (HMO)SM
  • Blue Cross Medicare Advantage (PPO)SM
  • Blue Cross Medicare Advantage (HMO-POS)SM
  • Blue Cross Group Medicare Advantage (PPO)SM
  • Blue Cross Group Medicare Advantage Open Access (PPO)SM
  • Blue Cross Community MMAI (Medicare-Medicaid Plan)SM

Diagnosis Related Group (DRG) Add-on Payment
For discharges of Medicare Advantage and MMAI members diagnosed with COVID-19, the weight of the assigned DRG has temporarily increased 20%. Providers should use the appropriate diagnosis code and date of discharge to identify members:

  • B97.29 (Other coronavirus as the cause of diseases classified elsewhere) is for discharges occurring on or after Jan. 27, 2020, and on or before March 31, 2020.
  • U07.1 (COVID-19) is for discharges occurring on or after April 1, 2020, through the emergency period.

Medicare Sequestration Suspended Through March 31, 2022
The Medicare sequester suspension period has been extended through March 31, 2022. (It previously was suspended starting May 1, 2020, and extended to Dec. 31, 2021.) Through March 31, 2022, BCBSIL is suspending the 2% sequestration reduction in Medicare claims payments. This applies to Medicare providers who provide care and services to our Medicare Advantage and MMAI members.

Sequestration reductions start April 1, 2022: As defined by federal legislation, the sequestration reduction will be set at 1% from April 1 to June 30, 2022. Sequestration reductions return to 2% starting July 1, 2022.

Call the number on the BCBSIL member ID card.

CMS Resources
Refer to the CMS website for Current Emergencies  and News Alerts .