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Managed Care and PPO Fee Schedule Update Effective June 2021

We are committed to improving health care quality and the member experience while keeping health care affordable. With this in mind, we will update our managed care and PPO fee schedules for dates of service beginning on and after June 1, 2021.

Our updated fee schedules for specific procedure codes will be based primarily on 2020 Centers for Medicare & Medicaid Services Resource-Based Relative Value Scale (CMS RBRVS). The current fee schedules are based primarily on 2014 CMS RBRVS.

The reimbursement we provide for specific procedure codes may change. The fee schedules may vary by specialties and services rendered. Reimbursement for procedure codes that will not be updated will continue to be reimbursed based on your current fee schedule.

Unless Horizon BCBSNJ provides notice that all or a part of these changes have been cancelled or postponed, changes will be applied to claims for dates of service on and after June 1, 2021.

Request a Sample Fee Schedule

You may request a sample of the new fee schedule at the individual CPT® level that applies to your practice and specialty.

To request a sample fee schedule, please email the following information to Fee_Requests@HorizonBlue.com:

  • Your tax ID number (including suffixes)
  • Your specialty (or specialties)
  • Your practice location ZIP code(s)

To help expedite your request, please include “Fee schedule effective June 1, 2021” in the subject line of your email.

CPT® is a registered mark of the American Medical Association.

Published on: March 1, 2021, 20:15 p.m. ET
Last updated on: July 8, 2021, 06:38 a.m. ET