Blue Shield of California facility fee schedule

The Outpatient Facility Fee Schedule applies to Blue Shield of California Facility outpatient surgery, outpatient radiology, outpatient clinical laboratory, and outpatient pharmaceuticals.

Reimbursement for outpatient services is based on the facility’s contractual agreement in effect at the time services are rendered. 

To identify which fee schedule file you should use, refer to the Provider Name Fee Schedule Crosswalk link below. If you do not see your facility listed in the Provider Name Fee Schedule Crosswalk, please contact your Blue Shield Network Manager. 

To calculate reimbursement for a fee schedule, you will need to insert the provider’s contractual reimbursement rate located in the agreement in Exhibit C, Section II Outpatient Services. 

Open the specific fee schedule assigned to you, and follow the instructions in the fee schedule table to populate the contracted rates. 

In the event your listing contains groupers not included in your payment schedule, reimbursement will be issued at the applicable rate for ungrouped surgical procedures.

Please reference the Hospital and Facility Guidelines for further explanation of the Outpatient Facility Fee Schedules. 

Provider Name Fee Schedule Crosswalk

Fee schedules

ASC fee schedules (Effective 4/15/25)

 ASC A

 ASC B

 ASC C           
 

Hospital fee schedules (Effective 4/15/25)

Hospital A

Hospital B            

Hospital C

Hospital D

Hospital E

Hospital F

Hospital G

Hospital H

Hospital I

Hospital J

Hospital K

Hospital L

Hospital M

Hospital N

Hospital O       
 

 Pharmaceutical fee schedules

Outpatient Pharmaceutical Q2 2025 (Effective 04/01/25)

Outpatient Pharmaceutical Q1 2025 (Effective 01/01/25)

Outpatient Pharmaceutical Q4 2024 (Effective 10/01/24)

Outpatient Pharmaceutical Q3 2024 (Effective 07/01/24)

Outpatient Pharmaceutical Q2 2024 (Effective 04/01/24)

Outpatient Pharmaceutical Q1 2024 (Effective 01/01/24)