Fellow LactNetters,
I have been on a fact finding mission. I live in Chattanooga, Tennessee...and apparently, Blue Cross Blue Shield of Tennessee has also jumped out there on reimbursement! I received a letter in June stating, "BlueCross BlueShield of Tennessee is excited to announce we are adding Lactation Consultants to our contracted specialties for our Commercial Networks. Our credentialing criterion specific to Lactation Consultants requires certification with IBCLC: Global Certification for Lactation Consultants (YAY, they know the difference between IBCLCs and other breastfeeding "specialists"). If you are interested in becoming a participating provider as a Lactation Consultant in one of our Commercial Networks, please call our Provider Service line." 
Well, I called and here is the information on the codes and reimbursement rates. It is my understanding (at present) these codes are also used by some physicians and other HCP. They (BCBST) are NOT reimbursing per hour, but by criteria. I am still in the dark as to what "an established patient" is...but, I am digging deeper. I don't know who (if anyone) negotiated these codes and/or rates.
 
99212- $40.65 OP $25.84 IP 	
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION; STRAIGHTFORWARD MEDICAL DECISION MAKING.
99213- $68.49 OP $51.08 IP	
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; MEDICAL DECISION MAKING OF LOW COMPLEXITY.
99214- $102.71 OP $78.64 IP	
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; MEDICAL DECISION MAKING OF MODERATE COMPLEXITY.
99215- $138.82 OP $111.03 IP	
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; MEDICAL DECISION MAKING OF HIGH COMPLEXITY.

Don't know if this helps...or just makes things more confusing.
Thanks to everyone who is working on this issue.
Marie Ivey, BSN, RN, LCCE, IBCLC
Chattanooga, Tennessee

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