Notice of Fee Schedule Maintenance Change
We’re making an important change to when our fee schedule maintenance will occur this year.
Currently, Premera Blue Cross maintains fee schedules by communicating changes that we make several times throughout the year, including our annual March fee schedule maintenance. However, to increase visibility and provide a 90-day notice, as required in your agreement, we’re adjusting the timing. Updates we’ve historically made in March will occur in July this year.
We encourage you to carefully review the details below and make any necessary adjustments to your billing practices in anticipation of these updates.
The following updates will occur in July:
- Updated pricing for existing codes:
- Revised interim and by report pricing for existing non-drug codes with the latest pricing information
- Revised resource based relative value scale (RBRVS), clinical laboratory (CLAB), durable medical equipment (DME), and parenteral and enteral nutrition (PEN) pricing
- Drug updates: Comprehensive updates will include:
- Average sales price (ASP) and average wholesale price (AWP) revisions
- Drug, immunization, and vaccine pricing adjustments
- Changes to drug tiering and radiopharmaceutical pricing
Reimbursement for these services will continue at the existing rates until the above changes go into effect in July. A detailed letter outlining these changes will be mailed to affected providers in April.
Please note that these updates may not apply to your practice’s reimbursement if you have a negotiated rate for the codes, drugs, or tiering impacted. Please reference your specific compensation exhibit or addendum to confirm if these updates apply to you