Effective 2/1/2024, we will begin payment for prolonged services with codes 99358-9, 99415-8, G0316-18, G0513-4, and G2212
Massage Therapy Coverage Update
Effective 7/1/2024, Blue Cross Blue Shield of Wyoming will not reimburse for the CPT massage therapy code 97124 when billed with a physical medicine procedure.
Good Habits
Provider Directory Validation Reminder
You can find the Provider Directory Validation guide under the Provider Resources section on the right rail of the website.
Providers can use the Directory Validation tool on the Availity Portal to find NPI and tax ID combinations.
The No Surprises Act (NSA) requires you confirm this information every 90 days.
We are aware that some Blue Cross Blue Shield of Wyoming members may be experiencing issues accessing some health care services as a result of an incident impacting Change Healthcare—an integral ‘background’ health care delivery vendor that connects payers, providers, and members.
There is no identified risk to Availity Systems, its technology, or Blue Cross Blue Shield of Wyoming.
We are gathering more information as the situation unfolds and continue to take precautions to protect our systems and members. Ensuring the safety and well-being of our members continues to be our top priority.
Availity EDI Update:
Availity has disconnected all inbound and outbound transactions from Change Healthcare as part of their security measures. Availity has shared an alternative path for providers who use Change Healthcare to upload transaction files. Please use the instructions included below.
These instructions can also be found in the Billing and Claims resources section under the provider tab at BCBSWY.com.
Availity Functions:
Our provider portal, Availity, has several functions to assist you, including the following:
As we further evaluate the implications of Change Healthcare’s outage, we will keep you updated. Ensuring the safety and wellbeing of our members remains our top priority.
Please reach out to BCBSWY at 800-442-2376 if you require additional assistance.
Some Users Experiencing Availity Issues for New Members
Blue Cross Blue Shield of Wyoming has updated t he Provider Manual that contains operational policies and procedures to keep you and your staff informed. You can find it at BCBSWY.com/Providers under Provider Resources. We recommend bookmarking this page as the manual is regularly updated and the online version contains the most current information.
Find Your Remits at Availity
Providers should get their remittances from Availity. Availity is the fast and easy service option that is available when you are.
As a reminder, log in to Availity and follow these simple steps to register:
Step 1: After Logging in Click “My Providers” then go to Enrollments Center
Only one week remains to register for our upcoming virtual training session for Predictal. This webinar is designed to help you maximize your Prior Authorization workflows.
You must register in order to attend. The one-hour training opportunity will begin at noon on Wednesday, Feb. 7, 2024.
Some Users Experiencing Availity Issues for New Members
Some BCBSWY Availity users are experiencing membership error issues when requesting a prior authorization for members effective 1/1/2024. We are currently working with Availity to resolve this. If you encounter an error with your prior authorization request, please submit a fax to us directly to us directly at 307-432- 2917.
Prior Authorization Training Webinar Available
After popular demand, we are excited to announce another virtual training session for Predictal to help you maximize your Prior Authorization workflows.
You must register in order to attend. The one-hour training opportunity will begin at noon on Wednesday, Feb. 7, 2024.
BCBSWY has received numerous questions regarding the Drug Prior Authorization box on Availity. If you see this option, please know this access is used by different payers — it is not used by BCBSWY.
All authorizations, regardless of CPT or HCPCS code, including drugs, should use the AUTHORIZATION REQUEST box.
See image below.
Authorizations and Referals
Digital Breast Tomosynthesis Billing Tips
BCBSWY will only reimburse Digital Breast Tomosynthesis (DBT) services billed using CPT codes 77063 and G0279. These codes represent DBT being performed as an add-on service.
The following are the four CPT codes that currently represent DBT services:
77061 – Digital breast tomosynthesis; unilateral
77062 – Digital breast tomosynthesis; bilateral
77063 – Screening digital breast tomosynthesis, bilateral; add-on
G0279 – Diagnostic digital breast tomosynthesis, unilateral or bilateral; add-on
Please note: DBT services billed using code 77061 or 77062 will be denied.
Please note we will be closed Monday, Jan. 15 in observance of EqualityDay. We will resume business Tuesday, Jan. 16, during our regular hours.
Ambulance Rate Increases
Effective 2/1/2024 we are updating our rates for ambulance services.
Ground ambulance services will have a 2.6% increase.
In-network air ambulance services will have a 3% increase for transport codes and a 4% increase for mileage codes. Out-of-network air ambulance reimbursement will remain as is.
CPT Code 83036 Billing Tips
As a reminder, Providers should include category II codes when billing CPT code 83036. Claims without the category II codes billed using CPT code 83036 will be denied. They will need to be resubmitted as a corrected claim.
Please use the codes below now to ensure proper categorization.
CPT 83036 for an HbA1c laboratory test will need the appropriate Category II code on the same claim.
CAT II codes are an informational code and should be billed with either a $0.00 charge or a $0.01 charge if required by your system or clearinghouse.
CAT II codes are for diagnostic/screening processes or results.
Category II Codes for HgbA1c
Code Usage
3044F-HbA1c
—– Less than 7.0%
3051F-HbA1c
—– Greater than or equal to 7.0% and less than 8.0%
3052F-HbA1c
—– Greater than or equal to 8.0% and less than 9.0%
We want to wish everyone a happy holiday season. Please note our holiday closures below.
We will be closed Monday, Dec. 25 in observance of Christmas.
We will resume business Tuesday, Dec. 26 during our regular hours.
We will be closed Monday, Jan. 1 in observance of New Years Day.
We will resume business Tuesday, Jan. 2 during our regular hours.
CPT Code 83036 Billing Tips
BCBSWY would like to remind Providers to include the category II claims when billing CPT code 83036. Starting in 2024, claims without the category II codes billed using CPT code 83036 will be denied. They will need to be resubmitted as a corrected claim.
Please use the codes below now to ensure proper categorization.
CPT 83036 for a HbA1c laboratory test will need the appropriate Category II code on the same claim.
CAT II codes are an informational code and should be billed with either a $0.00 charge or a $0.01 charge if required by your system or clearing house.
CAT II codes are for diagnostic/ screening processes or results.
Category II Codes for HgbA1c
Code Usage 3044F-HbA1c —– Less than 7.0% 3051F-HbA1c —– Greater than or equal to 7.0% and less than 8.0% 3052F-HbA1c —– Greater than or equal to 8.0% and less than 9.0% 3046F-HbA1c —– Greater than 9.0%
Effective 1/1/2024, a new Place of Service (POS) 27 code will be available for claims billing. The new POS code describes a non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered unhoused individuals.
Upon billing of this POS, records may be required for validation of correct billing.
Tip: If services are rendered in a homeless shelter, please use POS 04.
Faxed Authorization Requests Limited
Effective 12/15/2023, BCBSWY will no longer accept voicemail, mail, or faxed submissions for authorization requests except for the following items:
Any FEP authorization not accepted in Availity.
Any authorization triggering an error in Availity that has been reported to Provider Relations by calling 1-888-666-5188.
Any authorization for transplant services.
Any authorization for our pharmacy team.
All authorizations must be submitted through Availity.
Faxed Authorization Requests Limited
Provider Directory Validation Tool Reminder
Reminder: You can now find the guide under the Provider Resources section on the right rail of the website.
Providers can use the Directory Validation tool on the Availity Portal to find NPI and tax ID combinations.
The No Surprises Act (NSA) requires you to confirm this information with us every 90 days.
Please note that we began reimbursement for additional units of anesthesia for P3-P5: P3 1 unit, P4 2 units, P5 3 units on 11/1/2023.
This is in addition to the reimbursements that went into effect 4/1/2023 for qualifying circumstance codes 99100, 99116, and 99135.
Suprachoroidal Space Injection
Effective 1/1/2024, BCBSWY will require Suprachoroidal Space Injection of Pharmacologic Agent, also known as Xipere, claims to be billed with CPT code 67516 only.
Our offices will be closed in observance of the Thanksgiving holiday on Thursday, Nov. 23 and Friday, Nov. 24. We will return to office, Monday, Nov. 27.
Prior Authorization Added for LOQTORZI™
Please note that BCBSWY requires authorization for LOQTORZI™ (toripalimab-tpzi). This is the first and only PD-1 inhibitor for the treatment of patients with recurrent or metastatic nasopharyngeal carcinoma.
Medical Policy Reminder
As a reminder, be sure to check our Medical Policy for regular updates. Our Medical Policy can be found at BCBSWY.com/providers/policy/
