Effective Nov. 15, 2023, Blue Cross and Blue Shield of New Mexico is offering contracted providers a new revenue opportunity for Blue Cross Community CentennialSM members. Providers that are willing to expand their hours to help improve access to well child visits on weekends or after hours (visits after 5 p.m. MST or state-approved holidays) can receive a 20% rate increase for the codes listed below.
Codes
| 99381 | New Patient Well check Infant younger than 1 yr |
| 99382 | New Patient Well check child 1 yr - 4 yrs |
| 99383 | New Patient Well check child 5 yr - 11 yrs |
| 99384 | New Patient Well check adolescent 12 yrs - 17 yrs |
| 99385 | New Patient Well check 18 yrs or older |
| 99391 | Established Patient Well check Infant younger than 1 yr |
| 99392 | Established Patient Well check child 1 yr - 4 yrs |
| 99393 | Established Patient Well check child 5 yr - 11 yrs |
| 99394 | Established Patient Well check adolescent 12 yrs - 17 yrs |
| 99461 | Initial care per day, for E/M of normal newborn infant seen in other than hospital or birthing center. |
Providers will need to bill these codes with modifier TV for weekends and holidays or modifier UH for visits after 5 p.m. to receive the 20% rate increase. Urgent and emergency care providers are ineligible for this increase.
Additional Information
You may request an interactive copy of the fee schedule by following the steps on our Reimbursement Calculations page. Please contact your BCBSNM Provider Network Representative if you have any questions.
These rate increases may be discontinued at any time and without prior notice, although BCBSNM expects the program to continue until at least July 1, 2024, and will endeavor to communicate cessation by a future article in Blue Review.
As with all billable services, BCBSNM reserves the right to monitor utilization and to request and audit medical and other records in order to verify the appropriate use of billing codes and modifiers.