HealthCare News

Revised 2019 Fee Schedules Posted to Online Fee Schedule Portal

Issue: #410 SEP2019

Topic: Reimbursement


Revised fee schedules for Ambulatory Surgical Centers, Anesthesia, Applied Behavioral Analysts, APR-DRG, Home Medical Equipment, Hospital Outpatient, Licensed Marriage and Family Therapists, Licensed Public Health Units and Professional Payment Schedule have been posted to the online fee schedule portal.

Changes/Updates to specific fee areas:

  1. Anesthesia – Corrected per unit rate reflected for modifier QK.
  2. APR-DRG – Adjustments were made to the rates and weights for APR-DRGs 750-776.
  3. Licensed Marriage and Family Therapists – Procedure codes 97085 and 90853 were added to the fee schedule.
  4. Hospital Outpatient – Rates were revised for the following codes.


    Tier 1 Fee Schedule:
    23472 93299 A0430 A0431 A0435

    A0436 E1353 E1355 E2216 E2217

    E2218 L0623 L3761 Q4195 Q4196

    S8080 S9960 S9961 V2020 V2025

    V2750

    Tier 2 and 3 Fee Schedules:
    23472 93299 A0430 A0431 A0435

    A0436 E1353 E1355 E2216 E2217

    E2218 L0623 L3761 Q4195 Q4196

    S8080 S9960 S9961 V2020 V2025

    V2750 S9125 T2042 T2043 T2044

    T2045

  5. Licensed Public Health Units – Rates were revised for the following codes.

    90471 90472 90473 90474 96365

    96366 96367 96368 96372 96373

    96374 96375

  6. Professional Payment Schedule – Rates were revised for the following codes.

    D5282 D5283 D9944 D9945 D9946

  7. ABA – The July 2019 ABA Fee Schedule was revised and posted to the online fee schedule portal. The revised schedule includes new codes effective January 1, 2019.
  8. Ambulatory Surgical Centers – The ASC Fee Schedule was revised to reflect policy decisions related to the delay in transitioning ASCs to billing on the UB-04 and away from billing on the CMS-1500. Because ASCs are still billing on the CMS-1500, we have reverted to our previous policies regarding ASCs and will continue to follow those policies until claims processing is transitioned to the UB-04. The revised fee schedule is posted to the online fee schedule portal. Claims already processed will be reprocessed and adjusted to reflect current policy.
  9. Home Medical Equipment – Rates were revised for the following codes.

    V2020 V2025 V2750

Posted fee schedules are effective July 1, 2019, through June 30, 2020. The fee schedules are only available through the portal. If you have not registered for access to the portal, you can register at www.bcbsnd.com/FeeSchedules.

For questions regarding fee schedules, please email feeschedules@bcbsnd.com.