Blue Care Network updates professional fees July 1 > Michigan State Medical Society


Blue Care Network updates professional fees July 1

Blue Care Network will update fee schedules, effective with dates of service on or after July 1, 2016. This change applies to services provided to Blue Care Network commercial members.

Blue Care Network will use the 2016 Medicare resource-based relative value scale for most relative value unit-priced procedures for dates of service on and after July 1.

Changes in resource-based relative values can affect fees. Procedure code maximum fees will increase or decrease based on the new relative value units and Blue Cross Blue Shield of Michigan or Blue Care Network conversion factors.

In alignment with Blue Cross, the conversion factor used to calculate anesthesia base units for anesthesia procedures will increase and be aligned at $58 throughout Michigan. Also effective July 1, the percentage weight for the QK or QY modifier will be adjusted from 60 percent to 56 percent, and the QX modifier will be adjusted from 40 percent to 44 percent.

Blue Cross conducts a comprehensive analysis of professional provider performance and current economic indicators annually to calculate practitioner fees, with consideration for corporate and customer cost concerns. Blue Cross and Blue Care Network remain committed to reviewing professional provider performance to determine the need for increases or decreases in our maximum payments.

Only claims submitted with dates of service on or after July 1 will be reimbursed at the new rates.

Note: The Blue Cross Physician Group Incentive Program allocation (formerly known as the physician organization component) of professional fees remains the same this year. This component continues to be excluded from Blue Care Network professional fees.


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