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When multiple surgical procedures, which are incidental to each other, are performed during the same operative session, payment will be made only for the major procedure. If multiple surgical procedures, which are not incidental, are performed during the same operative session, the major procedure will be reimbursed the full allowance and the minor procedure will be reimbursed at 50 percent of the allowance. Prior to September 1, 2007, Blue Cross and Blue Shield of Alabama identified the major procedure as the surgical code with the highest submitted charge. For dates of service September 1, 2007 and after, Blue Cross assigns the major procedure status to the surgical code that has the highest fee schedule allowance.
This change was made to ensure that our Preferred Medical Doctors are reimbursed appropriately regardless of the submitted charge corresponding with the procedure that has the highest fee schedule allowance.
Last Updated May 2015