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Positive changes to the IBC standard fee schedule for certain professional providers

March 31, 2014

Effective July 1, 2014, positive changes will be made to the IBC and its affiliates (?IBC?) standard fee schedule for certain professional providers.

The following reimbursement changes under your current Professional Provider Agreement with IBC will be effective July 1, 2014, for services provided to HMO, POS, and PPO members enrolled in commercial and Medicare Advantage Benefit Programs:

  • Monthly PCP capitation. For commercial HMO and POS Benefit Programs, we are increasing the monthly capitation rates for primary care physicians (PCP) who are reimbursed on a capitated basis by 3.0 percent in aggregate. A larger percentage of the Per Member Per Month rate increase will be applied to those members with higher copayments; therefore, the increase at a practice level will vary. Medicare Advantage HMO capitation rates will not change in 2014.
  • Professional commercial services. For all commercial Benefit Programs, we are updating our fee schedule to increase Evaluation & Management codes for new, established, and preventive care office visits (CPT® 99201 ? 99215, 99381 ? 99397) billed by your specialty. These codes will be increased 3.0 percent; however, the aggregate increase at a practice level will vary based on the mix of services you provide.
  • Professional Medicare Advantage services. For all Medicare Advantage Benefit Programs, we are updating our fee schedule to reflect 2014 relative value units for Evaluation & Management codes (CPT 99201 ? 99240, 99256 ? 99499) for those practices reimbursed on a fee-for-service (FFS) basis.

Note: As a result of sequestration, the Centers for Medicare & Medicaid Services (CMS) reduced Medicare Advantage FFS payments by 2.0 percent as of April 1, 2013. The reduction for FFS payments that was incorporated into the August 1, 2013, fee schedule update will continue to apply unless sequestration reductions are overturned or revised. In the event that sequestration reductions are overturned or revised, IBC will adjust the Medicare Advantage FFS rates, prospectively, within 30 days of the date of the CMS notification.

For more information

For your reference, we have published a summary of the fee schedule changes by provider type on IBC NaviNet® Plan Central. To access these documents, select Independence Blue Cross from the Plan Central drop-down menu, and then refer to the Administrative Tools & Resources section.

If you have any questions regarding these fee schedule changes, please email us or call us at 1-888-289-3039 and leave a detailed message. Include your name, contact number, provider number, and the best time for us to call. You will receive a response within two business days.

Note: This information does not apply to providers contracted with Magellan Behavioral Health, Inc., an independent company.

NaviNet® is a registered trademark of NaviNet, Inc., an independent company.

CPT copyright 2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association


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