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News & Press: Payment & Policy

Evaluation Codes Effective January 1st

Tuesday, December 27, 2016   (0 Comments)
Posted by: Matthew Nicholas
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Please note that, effective January 1, the three new evaluation codes and one new re-evaluation code will be in place.

We have confirmed with Blue Cross Blue Shield of Illinois (BCBSIL) that claims submitted under the old codes will be returned unpaid. They can be resubmitted with the correct (new code) if denied.

All codes will be paid at the current rate, regardless of whether 97161, 97162, 97163 is used.BCBSIL anticipates the codes will be revalued in the new physician fee schedule that will be effective June 1, 2017.

Regardless of the payer, "it is important to use the correct code, even though (right now) all three codes may be paid at the same rate," noted Rick Rausch, IPTA's payment chair."In the development of the new evaluation codes, a lot of consideration was given on how the complexity of the evaluation should be a predictor of the overall length and intensity of the treatment plan. This should affect the valuation of the codes in the future.”

For more information about the changes, we encourage you to download and view the recorded November #THIRDTHURSDAY educational program “Payment Reform: Big Changes Go in Effect January 1st.


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