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Reimbursement Advocacy Alert

News & Media

Reimbursement Advocacy Alert

The Michigan State Medical Society (MSMS) Health Care Delivery Department receives news from several of  Michigan’s health plans and insurers related to policies, programs, and education opportunities. Below are some updates which may be of interest to physicians and other health care team members.

 National Fee Schedule for Vaccine Administration: October 2025 Update

Learn about coding updates (PDF) for:

  • AVTOZMA® for post-exposure prophylaxis or COVID-19 treatment
  • Newly FDA-approved products not yet assigned to a unique HCPCS Level II code

COVID-19 Vaccine Pricing for 2025–2026 Season

The Centers for Medicare and Medicaid Services (CMS) updated COVID-19 payment allowances for the 2025–2026 season. Visit the Vaccine Pricing webpage for the most current list of billing codes, including short descriptors and effective dates. There’s 1 new code for this season. CPT code 91323 is effective August 27, 2025:

  • Long descriptor: MNEXSPIKE COVID-19 mRNA (2025-2026) 10 mcg/0.2 mL, single dose High Risk 12-64Y/Over 65Y
  • Short descriptor: SARSCOV2 VAC 10 MCG/0.2ML IM

MIPS Final Scores and Targeted Review Are Available

The MIPS performance feedback is available, including your final score based on the data submitted and calculated for the 2024 performance year. If you believe an error has been made, you have approximately 60 days from September 9, 2025 to request a targeted review. Sign in to review your performance feedback or request a targeted review. Review the 2024 MIPS Performance Feedback FAQs (PDF) and 2024 Targeted Review User Guide (PDF) for more information. 

Recorded presentation for providers, office staff focuses on submitting reconsideration requests

Blue Cross Blue Shield of Michigan and Blue Care Network’s Provider Experience team has created a new on-demand training resources for health care providers and staff detailing how to submit claims reconsideration requests. As reported in theSeptember 2025 The Record, a recorded update of how to submit requests for claims reconsideration and how to locate resources to guide you through the process is now available.

To access the training site, follow these steps:

  1. Log in to the provider portal at availity.com.**
  2. Click on Payer Spaces on the menu bar, and then click on the BCBSM and BCN logo.
  3. Under Applications, click on the Provider Training Site tile.
  4. Click on Submit on the Select an Organization page.
  5. Existing users who used the same email address as their provider portal profile email will be directed to the training site. If you used a different email address, contact ProviderTraining@bcbsm.com to update your profile.

Those who don’t have a provider portal account can directly access the training through the Provider training website.**

For more information about using the provider training website, contact the provider training team at ProviderTraining@bcbsm.com.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

Availity® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.

HAP In-Person Provider Education Forums

HAP has scheduled three exclusive, no charge provider forums for October, where they will share the latest updates, enhancements and new tools from HAP and HAP CareSource. See what’s coming in 2026 and how it will benefit you and your patients, including:

  1. An overview of Hap and HAP CareSource 2026 plans and products
  2. New programs and initiatives launching in 2026, including an enhanced authorizations platform
  3. Demo of online applications
  4. Tips for working with HAP, HAP CareSource and ASR Health Benefits

Choose a forum date and location (lunch & giveaways provided):

  • Thursday, October 16, 2025, from 10:00 am – 1:00 pm, at the AC Hotel in Lansing, MI
  • Tuesday, October 21, 2025, from 10:00 am – 1:00 pm, at the Federick Meijer Gardens & Sculpture Park in Grand Rapids, MI
  • Wednesday, October 21, 2025, from 10:00 am – 1:00 pm, at the Bavarian Inn Lodge in Frankenmuth, MI