Medicare Advantage Enhanced Benefits
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1 Medicare Advantage Enhanced Benefits Fee Schedule: Revised November 30, 2017 Inclusion of a fee schedule amount for an item doesn t necessarily indicate coverage. Shaded cell indicates codes are no longer covered for the enhanced benefit. * 1.C Individual Consideration Note: If no fee is showing in the consecutive column that means the allowed amount remained the same. Physician Services Procedure code BCBSM MEDICARE ADVANTAGE ENHANCED BENEFIT - FEE SCHEDULE Location of service: F = Facility NF = Non-facility Effective 07/01/2015 Effective 07/01/2016 Effective 07/01/ F $54.94 $57.95 $ NF $71.51 $77.52 $ Same $35.77 $35.77 $ F $20.77 $19.55 $ F $21.07 $19.90 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ BCBSM Medicare Advantage Enhanced Benefits Fee Schedule Page 1 of 9 Revised 11/30/17 WP JAN 18
2 BCBSM MEDICARE ADVANTAGE ENHANCED BENEFIT - FEE SCHEDULE Physician Services Procedure code Location of service: F = Facility NF = Non-facility Effective 07/01/2015 Effective 07/01/2016 Effective 07/01/ Same $ $ $ Same $ $ $ Same $ $ $ Same $ $ $ Same $ $ $ Same $ $ $ Same $ $ $ Same $ $ $ A4261 Same $78.84 $78.84 $78.84 S0800 $1, $1, $1, S0800 (Bilateral) $1, $1, $1, S4981 Same $77.39 $77.39 $77.39 S4989 Same $ $ $ BCBSM Medicare Advantage Enhanced Benefits Fee Schedule Page 2 of 9 Revised 11/30/17
3 Medical Supplies HCPCS code DMEnsion Effective 01/01/2017 DMEnsion Effective 01/01/2018 A4266 $34.20 N/A A4452 $0.09 $300 lifetime maximum $0.09 $300 lifetime maximum A4520 $0.80 $0.79 A4554 $0.36 $0.28 A4634 $35.78 $20.24 A4649 I.C. I.C. A6530 $21.00 $21.00 A6533 $22.93 $22.93 A6534 $57.33 $35.98 A6535 $57.94 $35.98 A6536 $65.18 $65.18 A6537 $69.40 $69.40 A6538 $84.00 $84.00 A6539 $77.85 $74.98 A6540 $87.50 $74.98 A6541 $92.25 $75.60 A6549 I.C. I.C. A9282 $ $ E0241 $14.39 $14.39 E0242 $ $ E0243 $59.65 $16.96 E0244 $17.50 $17.50 E0245 $39.00 $34.95 BCBSM Medicare Advantage Enhanced Benefits Fee Schedule Page 3 of 9 Revised 11/30/17
4 Dental codes D0120 BCBSM Fee Schedule Effective 01/01/2017 SE MI $43.00 Non SE MI $41.00 BCBSM Fee Schedule Effective 01/01/2018 SE MI $43.00 Non SE MI $41.00 D0140 D0150 D0160 D0220 D0230 D0270 D0272 D0273 D0274 D1110 D4910 D9940 SE MI $70.00 Non SE MI $67.00 SE MI $74.00 Non SE MI $69.00 SE MI $ Non SE MI $ SE MI $24.00 Non SE MI $23.00 SE MI $17.00 Non SE MI $16.00 SE MI $24.00 Non SE MI $22.00 SE MI $37.00 Non SE MI $35.00 SE MI $45.00 Non SE MI $42.00 SE MI $53.00 Non SE MI $51.00 SE MI $76.00 Non SE MI $71.00 SE MI $ Non SE MI $ SE MI $ Non SE MI $ SE MI $70.00 Non SE MI $67.00 SE MI $74.00 Non SE MI $69.00 SE MI $ Non SE MI $ SE MI $24.00 Non SE MI $23.00 SE MI $17.00 Non SE MI $16.00 SE MI $24.00 Non SE MI $22.00 SE MI $37.00 Non SE MI $35.00 SE MI $45.00 Non SE MI $42.00 SE MI $53.00 Non SE MI $51.00 SE MI $76.00 Non SE MI $71.00 SE MI $ Non SE MI $ SE MI $ Non SE MI $ BCBSM Medicare Advantage Enhanced Benefits Fee Schedule Page 4 of 9 Revised 11/30/17
5 (Continued) BCBSM MEDICARE ADVANTAGE ENHANCED BENEFIT OTHER SERVICES Drug Injections Effective 11/01/2016 Effective 08/01/2017 J1050 $0.07 $0.07 J7300 $ $ J7302 (this code has been end-dated by CMS as of 12/31/2015) N/A N/A J7303 $33.17 $33.18 J7304 $4.99 $15.76 J7306 IC IC J7307 $ $ J7297 $ $ J7298 $ $ BCBSM Medicare Advantage Enhanced Benefits Fee Schedule Page 5 of 9 Revised 11/30/17
6 Home Infusion Therapy codes Effective 01/01/2017 Effective 01/01/ $ $ $66.44 $69.00 S5497 $8.20 $8.20 S5498 $8.20 $8.20 S5501 $11.71 $11.71 S5502 $35.13 $35.13 S5517 $35.13 $35.13 S5518 $35.13 $35.13 S $ S5521 $ $ S9061 $61.83 $61.83 S9325 $65.69 $65.69 S9326 $ S9327 $65.69 $67.04 S9328 $65.69 $66.08 S9329 $68.01 $71.86 S9330 $68.01 $68.40 S9331 $68.01 $68.01 S9336 $35.83 $46.58 S9338 $71.65 $71.65 S9346 $65.69 $65.69 S9347 $71.65 $71.65 S9348 $65.69 $65.69 S9351 $35.83 $46.58 S9355 $68.01 $68.01 S9357 $65.69 $70.46 S9359 $35.83 $46.58 S9361 $65.69 $65.69 BCBSM Medicare Advantage Enhanced Benefits Fee Schedule Page 6 of 9 Revised 11/30/17
7 Home Infusion Therapy codes Effective 01/01/2017 Effective 01/01/2018 S9363 $15.30 $20.19 S9364 $ $ S9365 $ $ S9366 $ $ S9367 $ $ S9368 $ $ S9370 $9.04 $11.75 S9372 $9.04 $11.75 S9373 $41.81 $54.35 S9374 $41.81 $54.35 S9375 $41.81 $54.35 S9376 $41.81 $54.35 S9377 $41.81 $54.35 S9379 I.C. I.C. S9490 $65.69 $65.69 S9494 $65.69 $75.76 S9497 $65.69 $76.50 S9500 $65.69 $72.26 S9501 $65.69 $72.26 S9502 $65.69 $72.26 S9503 $65.69 $72.26 S9504 $65.69 $72.26 S9537 $8.20 $10.66 S9542 $8.66 $11.43 Private Duty Nursing codes Effective 07/01/2016 Effective 01/01/2017 Effective 07/01/2018 S9123 $53.84 $54.65 $54.65 S9124 $46.59 $47.29 $47.29 BCBSM Medicare Advantage Enhanced Benefits Fee Schedule Page 7 of 9 Revised 11/30/17
8 Hearing codes Effective 01/01/2016 Effective 01/01/2017 S0618 $67.00 $67.00 V5010 $ $ V5020 $43.00 $43.00 V5030 $ $ V5040 $ $ V5050 $1, $1, V5060 $ $ V5070 $ $ V5080 $ $ V5100 $ $ V5120 $1, $1, V5130 $2, $2, V5140 $1, $1, V5150 $1, $1, V5170 $ $ V5180 $ $ V5190 $ $ V5210 $ $ V5220 $ $ V5230 $ $ V5242 $1, $1, V5243 $1, $1, V5244 $1, $1, V5245 $1, $1, V5246 $1, $1, V5247 $1, $1, V5248 $2, $2, V5249 $2, $2, BCBSM Medicare Advantage Enhanced Benefits Fee Schedule Page 8 of 9 Revised 11/30/17
9 Hearing codes Effective 01/01/2017 Effective 01/01/2018 V5250 $2, $2, V5251 $2, $2, V5252 $2, $2, V5253 $2, $2, V5254 $1, $1, V5255 $1, $1, V5256 $1, $1, V5257 $1, $1, V5258 $2, $2, V5259 $2, $2, V5260 $2, $2, V5261 $2, $2, V5299 I.C. I.C. Location of service: Provider Delivered Care Management F = Facility NF = Non-facility Effective 01/01/2017 Effective 07/01/2017 Effective 01/01/ Same $16.29 $16.29 $ Same $12.11 $12.11 $ F $15.05 $15.05 $ NF $16.73 $16.73 $ F $30.51 $30.51 $ NF $32.20 $32.20 $ F $46.41 $46.41 $ NF $47.65 $47.65 $ Same $99.26 $99.26 $ Same $49.84 $49.84 $49.84 G9001 Same $ $ $ G9002 Same $65.21 $65.21 $65.21 G9007 Same $33.10 $33.10 $33.10 G9008 Same $50.15 $50.15 $50.15 S0257 Same $33.00 $33.00 $33.00 BCBSM Medicare Advantage Enhanced Benefits Fee Schedule Page 9 of 9 Revised 11/30/17
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