Dec 30, 2022 • Policy Updates / Reimbursement Policies

Material Adverse Change (MAC)

This communication applies to Commercial and Medicare Advantage plans from Empire BlueCross BlueShield (Empire).

 

Beginning with dates of service on or after April 1, 2023, or the end of the public health emergency (PHE), whichever is later, reimbursement for COVID-19 laboratory service codes may be reduced for participating providers contracted with Empire.

 

New COVID-19 laboratory service codes were implemented and reimbursed at rates to meet the needs of providers during the PHE. Reimbursement will now be revised to Empire's standard reimbursement methodology for the following codes:

 

U0001

86328

87426

87811

0226U

U0002

86408

87428

0202U

0240U

U0003

86409

87635

0223U

0241U

U0004

86413

87636

0224U

 

U0005

86769

87637

0225U

 

 

If you have any questions regarding this notice, please contact Provider Services or use Availity* Live Chat, which is available during normal business hours. Go to www.availity.com and select Empire from the payer spaces drop-down. Then, select Chat with Payer and complete the pre-chat form to start your chat.


* Availity, LLC is an independent company providing administrative support services on behalf of Empire BlueCross BlueShield.


NYBCBS-CRCM-013071-22-CPN12449


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