Reimbursement Calculations

The Blue Cross and Blue Shield of New Mexico (BCBSNM) maximum allowable fee schedule utilizes certain aspects of the Medicare Resource Based Relative Value System (RBRVS) methodology. BCBSNM has recently reviewed the BCBSNM Maximum Allowable Fee Schedule and determined that an update to the Fee Schedule is appropriate. Additionally, BCBSNM determined after reviewing Maximum Allowable Fee Schedules for Blue Advantage HMO Network, Blue Community HMO Network, and, Blue Preferred Network that updates to those fee schedules for dates-of-service on and after Oct. 1, 2021 are appropriate as well. New codes will continue to be added to the system. Pricing for injectable drugs will be updated quarterly.

Therefore, for dates of service on and after Oct. 1, 2021, your reimbursement will no longer be calculated using the 2020 Maximum Allowable Fee Schedule that was effective for BCBSNM on Oct. 1, 2020, but rather, BCBSNM’s updated Maximum Allowable Fee Schedule as described above.

To evaluate the changes in your reimbursement that may result from BCBSNM's updated Maximum Allowable Fee Schedule, you may receive an interactive copy of the Schedule by submitting a Fee Schedule Request Form to FeeScheduleRequests@bcbsnm.com.

Please be sure to reference "Request for Interactive BCBSNM Maximum Allowable Fee Schedule" in the subject line along with the lines of business for which you are requesting an updated fee schedule. Please include your Tax ID in the body of the message. These Schedules are confidential and proprietary information and must be maintained as such per your Agreement.

BCBSNM values your participation in our programs and welcomes your input. If you have any questions or concerns, contact your Provider Network Services Representative for assistance.