Evaluation and Management Consultation Code Exceptions

Jul. 13, 2017

As a reminder, BCBSMT will begin zero pricing Evaluation and Management consultation codes on May 1, 2017. Providers are encouraged to report the appropriate inpatient or office/outpatient evaluation and management code in lieu of evaluation and management consultation codes. This change was made to align with the Centers for Medicare and Medicaid Services (CMS) 2010 change to eliminate the use of all consultation codes (inpatient and office/outpatient codes). In place of the consultation codes, CMS increased the work RVU’s for new and established office visits, increased the work RVU for initial hospital and initial nursing facility visits, and incorporated the increased use of these visits into the practice expense (PE) and malpractice calculations. CMS also increased the incremental work RVUs for the E/M codes that are built into the 10-day and 90-day global surgical codes.

The following BCBSMT compensation policies have been updated and published on the BCBSMT Secured provider portal March 1, 2017, and can be accessed by logging in to the Secure Provider Portal.

  • Ambulance Compensation Policy
  • Anesthesia Compensation Policy
  • Assistant at Surgery Compensation Policy
  • CDT, CPT, HCPCS, ICD-10-PCS Code and ICD-10-CM Update Policy
  • Clinical Laboratory Compensation Policy
  • Codes With No Other Standard BCBSMT Compensation Methodology Policy
  • Dental with Medical Benefits Compensation Policy
  • Drug Compensation Policy
  • Durable Medical Equipment Compensation Policy
    • Increase Payment Percent to 110%, effective 5/1/2017
  • Fee Schedule Clerical Error Policy
  • Home Health & Hospice Compensation Policy
  • Infusion Therapy Policy
  • Hospital Outpatient Diagnostic Lab, Machine Test, and Radiology Compensation Policy
  • Modifier Compensation and Reference Policy
  • Modifier 50- Bilateral Procedure and Multiple Surgery Reduction
  • Non-Physician Compensation Policy
  • Place of Service Compensation Policy
  • Professional Provider Compensation Update Policy
  • RBRVS and Anesthesia Conversion Factor
  • RBRVS Compensation Policy
    • E/M Consultation Code Zero Payment, effective 5/1/2017
  • Robotic Assisted Surgery Compensation Policy
  • Skilled Nursing Facility Policy
  • Web Publication Policy