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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

View requirements for Local Plan and BlueCard Out-of-Area members.

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Fee Schedule Request Procedure

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Fee Schedule Request Procedure

Providers who are reimbursed on a fee for service basis may request fee schedule information showing applicable maximum allowable reimbursement rates payable under the terms of their agreements. These requests will be accepted twice per year.  
Use the Fee Schedule Request Form on the previous page to submit requests for fee schedule amounts.  
After completing the form with the requested networks indicated, fax this form to 877-551-6184. 
Please note that the inclusion of a specific procedure code on the fee schedule requested should not be viewed as an assurance or guarantee of coverage or payment. BCBSGa members’ benefit plans vary widely and are subject to change based on the contract. Claim payment and procedure coverage determinations are made in accordance with an individual member’s benefits in effect on the date that services are rendered.  
BCBSGa will respond to your Fee Schedule Request within five (5) business days by email to the address provided by the requesting provider. 
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.