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BCBS of TN Payment Policy Updates Effective 10/1/2025: No consultations, payment reductions, and more.

Blue Cross Blue Shield TN Commercial and Bluecare Tenncare plans will no longer accept consultation services, as of October 1, 2025. CPT 99242-99245 & 99252-99255 will no longer be reimbursed, and providers should report the appropriate E/M that most describes the services performed, based on the setting, i.e., office outpatient, hospital, etc.

For problem focused E/M services reported on the same day as preventive visit CPT 99381-99387, a 50% payment reduction will be applied to the problem service E/M beginning on dates of service 10/1/2025. Modifier 25 is required to on the preventive visit and documentation most support the separate services. Preventive medicine service CPT 99381-99387 will be reimbursed at 100% when reported with the appropriate diagnosis codes.

BCBST News Alert Links Here: September & October

Click to view October's RCM newsletter