Fee Schedule Addendums Posted to Online Fee Schedule Portal

The January 2021 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 Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) since the July 2020 updates as well as updated rates for Evaluation and Management (E & M) CPT Codes 99201-99215 referenced in the December 1, 2020, Professional Services Reimbursement Notice. The rates in the addendum will be in effect January 1, 2021, to June 30, 2021. The annual update is scheduled to occur July 1, 2021.
Payment is based on the lesser of charges or fee schedule amount. Specific product discounts or contractual arrangements that you may have with Blue Cross Blue Shield of North Dakota (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 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 Reimbursement Webpage.

The existence of a procedure code on these fee schedules is not a guarantee 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 These fee schedules may contain procedure codes that have been replaced by other HCPCS or CPT® codes.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.
Please know that the portal for the online fee schedule requires activity every 120 days. If an account has been inactive for more than 120 days, the account will be disabled. If your account has been disabled due to inactivity, please contact Support Services at 1-800-544-8467 during the hours of 8 a.m.-4:30 p.m. CST or by email at portals@bcbsnd.com.

If you do not have an account and would like access to BCBSND’s fee schedules, please visit www.bcbsnd.com/feeschedules.

For questions concerning this notice, please contact feeschedules@bcbsnd.com.