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May 2025
Annual fee schedule updates: Effective July 1
We have completed our review of the annual CMS fee changes and revised our fee schedules. You can preview them on the AZ Blue provider portal starting June 1. To see the updates, go to “Provider Resources > Guidelines > Claim Pricing.” Then select one of the fee updates links: ASC, Outpatient, Professional, or Unclassified Drug. 

This article and our online posting of the updates serve as the advance notice of these fee schedule changes that is required by our provider participation agreements.
Our updates
Our annual review takes place during the first part of the year with an effective date of July 1. The yearly update is considerably broader in scope than our quarterly updates and typically affects a large number of codes. The annual update can also include code edit changes in our claim editing software.

Our other fee updates are effective January 1, April 1, and October 1, unless we notify you of a delay. These quarterly updates are limited to medical pharmacy drug fees, new codes established by CMS and the AMA, and other new fees for services or revenue codes that did not previously have an assigned fee.

Please note that in addition to the April 1, 2025, drug fee updates, there were also some new fees for revenue codes for the ASC and Outpatient fee schedules.
AZ Blue proprietary fee schedule sources
For commercial plans, we base our fee schedules on a number of sources that may influence the need for changes. These include:
• Medicare fee schedule updates
• Claim information
• Competitive pricing data
• Feedback from AZ Blue network providers
We modify fees based on ongoing claim analysis. We also consider market updates such as CMS code changes, pricing for new drugs, price changes for listed drugs, correction of over- or undervalued fees, and other market shifts.
Additional Resources
You can access our code edit guidelines and the C3 code edit transparency tool on the AZ Blue provider portal at “Provider Resources > Guidelines > Claim Coding > Code Edit Guidelines and C3 Tool.” We update these resources as needed.
  
If you have questions, feel free to reach out to your  Provider Relations Contact or call Provider Partnerships at 1-800-232-2345, ext. 4231.

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