Fee Schedules for Physicians in the North Country Region
Use the links below to print or download copies of our physician fee schedules. For your convenience, files are offered in two formats.
- PDF Format - requires Acrobat Reader. If you don't already have it installed, you can download it free at Adobe.com.
- Excel Spreadsheets - requires Microsoft Excel software.
Note: For codes that are in the Office-Based Surgery Program, the applicable add-on is included in the NF Rate.
Every attempt has been made to ensure that these fee schedules are accurate, but there may be instances when inaccuracies occur. In such a case, our payment will be based on the official fee schedules maintained by Excellus BlueCross BlueShieldUnivera Healthcare and we will update these fee schedules accordingly.
For dates of service between January 1, 2022, and September 30, 2022, new 2022 CPT codes will be paid using the current conversion factors effective as of August 1, 2021, multiplied by 2022 GPCI-adjusted relative value units (RVUs). If Medicare has not yet established rates, services will be priced at the Health Plan’s discretion. Should Medicare establish rates in the future, the Health Plan will utilize the same relative value units within approximately 45 days of the Centers for Medicare & Medicaid Services publication.
For dates of service on or after October 2022 the 2022 GPCI-adjusted RVUs will be multiplied by the conversion factors which will become effective on October 1, 2022.
Office Surgery Pilot Program
This pilot program promotes the use of office-based surgery, with an emphasis on safety and convenience for our members and fair and consistent reimbursement for our participating physicians. The pilot provides an extra payment, in addition to the professional fee for targeted services where Medicare does not currently apply a site of service differential or that differential may not fully compensate for the additional cost of performing the service in the office location.
Please note that effective August 1, 2016, this pilot program will be limited to commercial products only. An updated list of the pilot’s approved service codes with add-on rates effective August 1 is located under the Fee Schedules tab. The office surgery add-on rates are included in the Non-Facility rates noted within the Fee Schedule.
We will continue to monitor the cost-effectiveness of the pilot program and will provide 90 days’ advance written notice if there are any changes.