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Reimbursement Rates for 2021 Procedure Codes

Each year, the American Medical Association (AMA) editorial board updates the list of procedure codes by adding new codes and revising or deleting certain existing codes. Information on new and updated CPT® codes is available from the AMA.

The Centers for Medicare & Medicaid Services (CMS) reviews this updated information and assigns Relative Value Units (RVUs) based on its analysis of the labor and resource input costs to each newly identified CPT code. Once CMS makes its RVU information available, Horizon BCBSNJ uses this data to help us establish new rates for these new codes.

CMS began releasing RVU information in December 2020. Horizon BCBSNJ is in the process of obtaining all necessary information required to update our pricing files.

We anticipate that our pricing file updates will be completed no later than February 1, 2021.

The processing of certain 2021 claims that include new or revised procedure codes may be delayed until our files are updated. We apologize for any inconvenience this may cause.

All impacted claims will be finalized following the completion of our file updates. There is no need to resubmit claims or to submit claim appeals.

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

Published on: January 12, 2021, 13:39 p.m. ET
Last updated on: April 22, 2021, 05:34 a.m. ET