49 11/2005
Fee Schedule Request Procedure
According to their contractual agreement, providers who are reimbursed on a fee-
for-service basis may request complete fee information showing applicable fee
schedule amounts or request up to one hundred (100) CPT codes customarily and
routinely used. These requests will be accepted twice per year.
Use the Fee Schedule Request Form on the following page to submit requests for fee
schedule amounts. The form is also available on our web site, www.bcbsga.com.
Requests can be made by email, fax or phone call.
If submitting a request via email, please use the online form available on our web site,
www.bcbsga.com
under Forms and Links. After completing the form with the
requested CPT codes, send this form as an attachment to the following email
addresses, based upon the location of the participating provider:
• IPSUNorth@bcbsga.com - Participating providers practicing in the Atlanta metro
area and all areas north of Atlanta.
• IPSUSouth@bcbsga.com - Participating providers practicing in all areas south of
Atlanta.
If submitting a request via fax, fax the completed Fee Schedule Request Form to 404-
467-2631.
If submitting your request via phone call, please use the following phone numbers
based upon the location of the participating provider:
• Atlanta area providers please call 404-231-0428
• North Georgia providers please call 888-706-3475
• South Georgia providers please call 800-428-4446
BCBSGa/BCBSHP will respond to your Fee Schedule Request within five (5) business
days by email, fax or return phone call, based upon the method chosen by the
provider.