The January 2023 Fee Schedule Addendums have been posted to the online fee schedule portal. The addendums reflect the rates that have been established for the new codes released by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) since the last fee schedule update. For Medicaid Expansion, this includes codes released since January 2022, and these rates will be in effect through December 31, 2023. For Commercial, this includes codes released since July 2022, and these rates will be in effect through June 30, 2023, unless otherwise indicated in your specific provider contract.
Going forward, Blue Cross Blue Shield of North Dakota (BCBSND) will publish new code fee schedules on a quarterly basis which will only include those new codes applicable to that quarter’s release. Those rates will be in effect until the next annual fee schedule update.
Payment is based on the lesser of charges or fee schedule amount. Specific product discounts or contractual arrangements that you may have with BCBSND are not reflected in the fee schedules. These fee schedules are considered confidential and proprietary and are intended for the exclusive use of BCBSND participating providers. Participating providers may only use or disclose the information for the purpose of practice management, billing activities and other business operations, or to disclose the information to the Insurance Commissioner. Any other use or redistribution of these fee schedules without the written consent of BCBSND is prohibited.
The most current version of each code set (ICD-10-CM, CPT® and HCPCS) must be used and services coded to the required level of specificity. Services are billed based on the definitions, units and parenthetical information as identified by the AMA for CPT® and the CMS for HCPCS. Code sets are updated based on the release of new codes by the owners of the code sets (AMA, CMS, etc.). Codes cannot be used prior to their effective date or after their termed date. Specific reimbursement and coding guidelines are located on the Coding & Reimbursement Webpage.
The existence of a procedure code on these fee schedules is not a guarantee whether the code is valid or covered. These fee schedules may contain procedure codes that have been replaced by other HCPCS or CPT® codes. Edits in BCBSND’s system check for procedure validity and will reject invalid codes. Some codes may represent services for which benefits are not available.
Questions?
For questions concerning this notice, please contact feeschedules@bcbsnd.com.
How to Access to the Online Fee Schedule Portal
Visit https://Feeschedule.bcbsnd.com/FeeSchedule/FeeScheduleManagement/List to access your account. Please know the portal for the online fee schedule requires activity every 120 days (about four months). If an account has been inactive for more than 120 days (about four months), the account will be disabled. If an account has been disabled due to inactivity, please contact Support Services at 1-800-544-8467 during the hours of 8:00 a.m. – 4:30 p.m. CST or by email at portals@bcbsnd.com.
If you do not have an account and would like to access to BCBSND’s fee schedules, please visit https://feeschedule.bcbsnd.com/FeeSchedule/.
