Bcbs of texas reimbursement policy. Blue Cross and Blue Shield of Texas .

Bcbs of texas reimbursement policy Here are some commonly used forms and documents for conducting business with Blue Cross and Blue Shield of Texas (BCBSTX). 4, 2021 (Blue Cross and Blue Shield of Texas Only) Description: Policy Number: CPCP015 . /Endoscopy Ctr. 0 Enterprise Clinical Payment and Coding Policy Committee Approval Date: September 24, 2024 Plan Effective Date: October 4,2024 Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, Blue Cross and Blue Shield of Texas (BCBSTX) has implemented clinical payment and coding policies based on criteria developed by specialized professional societies and national guidelines (e. 735026. 758132. Browse commonly requested forms to find and download the one you need for pharmacy, enrollment, claims and more. 19, 2021. BCBSTX Clinical Payment and Coding Policies are based on criteria developed by specialized professional societies, national guidelines (e. Under this policy, Blue Cross and Blue Shield of Texas (BCBSTX) Outpatient Surgery Codes with Reimbursement Increase When Performed at an Ambulatory Surgery Center Page | 1 Applies to Blue Cross and Blue Shield of Texas Commercial Plans The presence of codes on this list does not necessarily indicate coverage under the member benefits contract. 11. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2021 – 12/31/2021 : SMBlue Advantage Plus Bronze 303 Coverage for: Individual/Family | Plan Type: HMO Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Policy Number: CPCP024 Version 1. Claim Status; Claim Review Process; Interactive Voice Response (IVR) System Blue Cross and Blue Shield of Texas (BCBSTX) uses the BCBSTX Provider website to publish disclosure notices. O. This update has been posted to the provider website. Page 1 of 2 Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual For out-of-network providers in Texas, the CPCP is effective as of the date the policy is posted to the BCBSTX provider website. m. On June 1, 2021, Blue Cross and Blue Shield of Texas (BCBSTX) will begin additional reviews of claims after payment to make sure they adhere to our reimbursement policy for multiple surgical procedures. , Milliman Care Guidelines) and the CMS Provider Reimbursement Manual The following resources provide you with the information needed to administer Blue Cross and Blue Shield of Texas (BCBSTX) plans for your patients. Claim Status; Claim Review Process; Interactive Voice Response (IVR) System Texas Six (6) Month State Continuation of Insurance Application Form (Post COBRA) 6month. I have a question about PPO/POS/Indemnity Plans: 1-800-521-2227 8 a. * BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. Blue Cross and Blue Shield of Texas, a 12/05/2023 CPCP004 NICU Level of Care Authorization and Reimbursement Policy Update Effective 03/06/2024. Updated 05/12/2021 — SA Modifier and Midlevel Provider Contracting Update Blue Cross and Blue Shield of Texas (BCBSTX) directly contracts and credentials with Midlevel providers. Providers should refer to the Clinical Payment and Coding Policy Reimbursement of OB Anesthesia Add-On Codes 01968 and 01969 procedure (01967) is billed with either 01968 and/or 01969, BCBSTX allows a combined maximum of 32 points. Most of our group and fully insured plans currently include a time period for continuity of care at in-network reimbursement rates when a provider leaves our networks. Health care providers are expected 12/07/2023. Medical policies, both new and revised, are used as guidelines to determine health care benefits for most Blue Cross and Blue Shield of Texas (BCBSTX) members, unless otherwise indicated. Blue Cross and Blue Shield of Texas (BCBSTX) has updated the Clinical Payment and Coding Policies page to include annual review update to the following policies effective October 15, 2020: Chiropractic Services ; Co-Surgeon/Team Surgeon Modifiers Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Prior Authorizations Lists for Designated Groups; Recommended Clinical Review Option; Prior Authorization Exemptions (Texas House Bill 3459) Claims Filing Tips. Policy Number: CPCP024 Version 5. Department of Health and Human Services (HHS). Affordable Care Act The Affordable Care Act provides coverage to individuals and families who do not have access to employer-sponsored insurance and/or are not eligible for government programs (Medicare, Medicaid, Federal Employee Program, etc). Blue Cross and Blue Shield of Texas has revised the Clinical Payment and Coding Policy (CPCP) for the CPCP023 Modifier Reference effective June 26, 2023. Surgery performed in a hospital can cost nearly three times more than an ASC. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Blue Cross and Blue Shield of Texas (BCBSTX) gives health care benefits and access to care to help your child stay well. Dental Claim Form – Members should use this form to file dental claims for reimbursement that are not filed by their dental provider. Blue Cross and Blue Shield of Texas has updated with minor revisions as part of its annual review, the CPCP008 Psychological and Neuropsychological Testing Clinical Payment and Coding Policy (CPCP) effective December 07, 2023, and posted it to the provider website:. Anesthesia Payment and Billing Update ; Participating Provider Fee Schedule Requests: Professional Providers: For out-of-network providers in Texas, the CPCP is effective as of the date the policy is posted to the BCBSTX provider website. You can also learn how to get the most of your pharmacy benefits. 33. Policy Number: CPCP011 Version 2. N/A. 0 Enterprise Clinical Payment and Coding Policy Committee Approval Date: March 31, 2021 Plan Effective Date: July 15, 2021 (Blue Cross and Blue Shield of Texas) Description This policy serves as a general reference claim submission guideline for appending modifiers to the appropriate procedure codes. 04/12/2019: 07/15/2019: Revised Texas Clinical Payment and Coding Policy – Telemedicine and Telehealth Services. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association General Reimbursement Information. Blue Cross and Blue Shield of Texas Reimbursement Schedules and Related Information. Application/Change Form – use this form to apply for group coverage or to make changes to an existing BCBSTX policy. 1, 2022. 10/24/2023. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Here are some commonly used forms and documents for conducting business with Blue Cross and Blue Shield of Texas (BCBSTX). Select Network), Blue PremierSM, Blue Effective May 1, 2022, Blue Cross and Blue Shield of Texas (BCBSTX) will implement its new program with Avalon for claims for certain outpatient laboratory services provided to many of our commercial members. Provider Specialties Included: Child & Adolescent Psychiatry; Psychiatry Jan. CPCPs are not intended to provide billing or General Reimbursement Information. The following grid provides a list of the recommendations released by the USPSTF, ACIP, HRSA, or Bright Observation Services Policy Clinical Payment and Coding Policy . PostCOBRA. Reimbursement Information: Guidelines: Commercial Reimbursement Policy Updates for February 1, 2024 Reimbursement Policy. 0 Clinical Payment and Coding Policy Committee Approval Date: February 24, 2022 Effective Date: March 7, 2022 General Reimbursement Information. 03/28/2019: 07/01/2019: New Texas Clinical Payment and Policy Number: CPCP002 Version: 1. Members should use this form to file dental claims for reimbursement that are not filed by Keep in mind that determination of coverage under a member's benefit plan does not necessarily ensure reimbursement. Professional. Policy Blue Cross Blue Shield North Carolina (Blue Cross 08/10/2022. Members with an Individual health plan should use this form to request continuation of coverage on their existing policy for a dependent who is incapable of self Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Prior Authorizations Lists for Designated Groups; Recommended Clinical Review Option; Prior Authorization Exemptions (Texas House Bill 3459) Claims Filing Tips. com to find our policies and understand the basis for reimbursement if a service is covered by a patient's benefit plan. , Milliman Care Guidelines) and the CMS Provider Reimbursement Manual. Clinical Payment and Coding Policy Updates . Policy Number: CPCP020 Version 4. 14, 2024, Blue Cross and Blue Shield of Texas is updating the Clinical Payment and Coding Policy, CPCP010 - Anesthesia Information. Blue Cross and Blue Shield of Texas has revised the Clinical Payment and Coding Policy for the CPCP033 Telemedicine and Telehealth/Virtual Health Care Services Policy effective May 1, 2024. , MCG TM), the Centers for Medicare & Medicaid Services (CMS) Provider Reimbursement manual and others (provided upon request). Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policies are based on scientific and medical research. JANUARY 2023 . S. Blue Cross and Blue Shield (BCBS) companies offer many different coverage options designed to best fit your needs. View Medical Policies. Claim Status; Claim Review Process; Interactive Voice Response (IVR) System 08/10/2022. . Health care providers are expected to exercise independent medical judgment in providing care to patients. Anesthesia Payment and Billing Update ; Participating Provider Fee Schedule Requests: Professional Providers: Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Blue Points Program Rules are subject to change without prior notice. October 07, 2020. Reimbursement changes and updates for the commercial HMO and PPO practitioners will be posted under Standards and Requirements / General Reimbursement Information / Reimbursement Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Reimbursement Changes and Updates: Reimbursement Changes/Updates Note: You received a letter in May 2011 regarding a change in the maximum allowable fee schedule used for BlueChoice ®, HMO Blue ® Texas, and ParPlan effective September 1, 2011. Claim Status; Claim Review Process; Interactive Voice Response (IVR) System Call Customer Service at the number listed on your member ID card. Dental Claim Form – Members should use this form to file dental claims for reimbursement these charges to Blue Cross and Blue Shield of Texas. o Virtual Check-ins-Remote evaluations of recorded video or images submitted 02/29/2024. They are often used as guidelines for coverage determinations in health care benefit programs. The means by which Blue Cross and Blue Shield of Texas (BCBSTX) exchanges member data with providers will change dramatically over the next several years. Tips to help locate your policy: If you have coverage through your employer, then your policy would be in the group market. Effective January 1, 2023, Blue Cross and Blue Shield of Texas (BCBSTX) will increase the maximum allowable standard fee schedule reimbursement for the following specialties for commercial members in certain networks*. Effective August 1, 2022, Blue Cross and Blue Shield of Texas (BCBSTX) increased the maximum allowable standard fee schedule reimbursement for the following specialties for commercial members in certain networks*. Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Prior Authorizations Lists for Designated Groups; Recommended Clinical Review Option; Prior Authorization Exemptions (Texas House Bill 3459) Claims Filing Tips. Blue Choice PPO SM, Blue Essentials SM, Blue Premier SM, Blue Advantage HMO SM, MyBlue Health SM, Blue High Performance SM Schedules; Schedule Request; Compound Drugs. A policy is automatically cancelled for nonpayment of its premium. These manuals set forth the detailed policies, procedures and requirements necessary for participation in the BCBSTX contracting provider networks. For detailed information refer to CPCP033 Telemedicine and Telehealth Services on the Clinical Payment and Coding Policies page. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Blue Cross and Blue Shield of Texas (BCBSTX) has updated the Clinical Payment and Coding Policies page to include an update to the Telemedicine and Telehealth Services effective January 1, 2021. 2023 Texas Policy Documents. Additional sources are used and can be provided upon request. The following resources provide you with the information needed to administer Blue Cross and Blue Shield of Texas (BCBSTX) plans for your patients. 1 Check if any of these changes may impact you. BCBSTX covers all medically necessary care that Medicaid covers. Disclosure notices can include but are not limited to fee schedule updates and reimbursement policies, clinical payment and coding policies, provider manuals and/or benefit and medical policy changes which may impact claim payments. Anesthesia Payment and Billing Update ; Participating Provider Fee Schedule Requests: Professional Providers: Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Prior Authorizations Lists for Designated Groups; Recommended Clinical Review Option; Prior Authorization Exemptions (Texas House Bill 3459) Claims Filing Tips. March 1, 2021. (NICU) Level of Care Authorization and Reimbursement Policy. Anesthesia Payment and Billing Update ; Participating Provider Fee Schedule Requests: Professional Providers: Blue Choice PPO SM, Blue Essentials SM, Blue Premier SM, Blue Advantage HMO SM, MyBlue Health SM,Blue High Performance SM, ParPlan Schedules. Technology determinations used in Medical Policies are The following acronyms have been utilized throughout this reimbursement policy ACIP: Advisory Committee on Immunization Practices Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. use this form to add more dependents to your policy. The Clinical Payment and Coding Guidelines are not Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Prior Authorizations Lists for Designated Groups; Recommended Clinical Review Option; Prior Authorization Exemptions (Texas House Bill 3459) Claims Filing Tips. Description . Medical Policies: We Want Your Feedback. April 10, 2021. 0 . Blue Cross and Blue Shield of Texas (BCBSTX) will be conducting post pay claim reviews of certain diagnostic cardiovascular and ophthalmology services to ensure reimbursement adheres to BCBSTX reimbursement policy for Multiple Procedure Payment Reduction (MPPR) of the Technical Component (TC) of Certain Diagnostic Cardiovascular and Ophthalmology Now effective Aug. The changes – upgrading ANSI v4010 to ANSI v5010 and ICD-9 to ICD-10 – are required by a new directive from the U. Members should use this form to file dental claims for reimbursement that are not filed by Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Disclosure notices can include but are not limited to fee schedule updates and reimbursement policies, clinical payment and coding policies, provider manuals and/or benefit and medical policy changes which may impact claim payments. Provider Specialties Included: Child & Adolescent Psychiatry; Psychiatry Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Prior Authorizations Lists for Designated Groups; Recommended Clinical Review Option; Prior Authorization Exemptions (Texas House Bill 3459) Claims Filing Tips. This completed form, together with the itemized bills, should be submitted to: Blue Cross and Blue Shield of Texas P. Please complete every item on claim form. Last Review: 06/2024 . Claim Status; Claim Review Process; Interactive Voice Response (IVR) System Effective May 1, 2022, Blue Cross and Blue Shield of Texas (BCBSTX) will implement its new program with Avalon for claims for certain outpatient laboratory services provided to many of our commercial members. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield symbols are marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Claim Status; Claim Review Process; Interactive Voice Response (IVR) System 07/30/2024 Annual Review: CPCP004 Neonatal Intensive Care Unit/NICU Level of Care Authorization and Reimbursement Policy Updated Effective 07/31/2024. Number: CPCP001 Version 2. Anesthesia Payment and Billing Update ; Participating Provider Fee Schedule Requests: Professional Providers: Blue Cross and Blue Shield of Texas has revised the Clinical Payment and Coding Policy (CPCP) for Pneumatic Compression Devices – Outpatient Use effective April 12, 2022. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue The following resources provide you with the information needed to administer Blue Cross and Blue Shield of Texas (BCBSTX) plans for your patients. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Make the check payable to Blue Cross and Blue Shield of Texas or BCBSTX. 0915 Disclosure notices can include but are not limited to fee schedule updates and reimbursement policies, clinical payment and coding policies, provider manuals and/or benefit and medical policy and prior authorization changes which may impact claim payments. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve The means by which Blue Cross and Blue Shield of Texas (BCBSTX) exchanges member data with providers will change dramatically over the next several years. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross For HealthSelect SM of Texas, Consumer Directed HealthSelect SM of Texas, HealthSelect SM and Consumer Directed HealthSelect SM Out-of-State, the prior authorization requirement is waived for preventive colonoscopies performed by in-network providers when the intent of the procedure is preventive and billed with modifier 33, regardless of the findings. This update has been posted to the provider website. This is NOT insurance. Providers must follow all Plan rules regarding reimbursement. Enterprise Clinical Payment and Coding Policy Committee Approval Date: 03/21/2018 Effective Date: 09/01/2018 (Blue Cross and Blue Shield of Texas) Description: The practice of chiropractic focuses on the relationship between structure (primarily the spine) Proper coding is essential for correct reimbursement. All other marks and trade names are the property of their respective owners. 1, 2024. Cultural Diversity and Mental Health: Considerations for Policy and Practice (2018) Frontiers Public Health; Electroconvulsive Therapy. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Wasted/Discarded Drugs and Biologicals Policy Policy Number: CPCP017 Version 1. 15, 2021. 2024 Schedules effective 2/1/24; 2020 Schedules effective 3/1/20 - 1/31/24; 2017 Schedules effective 10/1/17 - policies, clinical payment and coding policies as well as coding software logic. The use and disclosure of this information is restricted under Texas Insurance Code Section 1301. In some cases, your actual policy document may be available through the links below. Use this dental application for 2024 plans effective January 1, 2024. In order to help make it easier to locate your policy, they are divided into categories, including individual, small group, and large group market policies. 136(b), Texas Insurance Code Section 843. Claim Status; Claim Review Process; Interactive Voice Response (IVR) System Reimbursement Information Laboratory panels outlined below were developed for coding purposes only and are defined by AMA and published in the CPT® codebook under Pathology and Laboratory, Organ or Disease-Oriented Panels. General Information. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 763303. Be sure to check eligibility and benefits before rendering service(s) to make sure a procedure is a Policy Number: CPCP020 Version 2. Refer to Clinical Payment and Coding Policies under Standards and Requirements on the provider website to review the current CPCPs. View the current policies below: For Clinical Payment and Coding policy effective dates for in-network providers, please refer Durable Medical Equipment Reimbursement Schedules / Prosthetics & Orthotics Reimbursement Schedules. In the conversion factor table included in the letter, CPT codes 98925-98929 were listed with the Here are some commonly used forms and documents producers need for conducting business with Blue Cross and Blue Shield of Texas. Surg Ctr. Blue Cross and Blue Shield of TX has revised the following Clinical Payment and Coding Policies (CPCP) effective July 15, 2021 and has been posted to the provider website: Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Blue Cross and Blue Shield of Texas medical policies and other general reimbursement policies are routinely reviewed. Box 660044 Dallas, Texas 75266-0044 1 Insured/subscriber’s Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Prior Authorizations Lists for Designated Groups; Recommended Clinical Review Option; Prior Authorization Exemptions (Texas House Bill 3459) Claims Filing Tips. Cont. Implant Payment and Coding Policy Policy Number: CPCP007 Version: 1. Stock # / Date: Claim Forms and Order Forms: Texas Form # J30D. View the current policies below: For Clinical Payment and Coding policy effective dates for in-network providers, please refer Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an This Preventive Services Reimbursement policy is not intended to impact care decisions or medical practice. 0 Clinical Payment and Coding Policy Committee Approval Date: December 1, 2023 Plan Effective Date: March 7, 2024 (Blue Cross and Blue Shield of Texas Only) Reimbursement Information: Reimbursement for presumptive testing will be considered for claim submissions containing CPT codes 80305, 80306 and 80307. Telemedicine and Telehealth Services Effective 5/10/2020 General Reimbursement Information. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association some sites may require you to agree to Most often, your provider will submit a claim for reimbursement on your behalf. The forms below are in portable document format (PDF). Highmark Western and Northeastern New York Inc. 0122 Effective Date: July 12, 2021 (Blue Cross and Blue Shield Of Texas Only) Description The purpose of this document is to clarify the payment policy for covered psychological and neuropsychological testing. With the upcoming 2021 implementation of the ClaimsXten edit of the SA modifier for non-payable services which will result in the SA modifier being non-reimbursable, we would If you bought a Blue Cross and Blue Shield of Texas health plan, changes to your 2025 pharmacy benefit program may start on January 1, 2025. Effective Date: December 1, 2021 (Blue Cross and Blue Shield of Texas) This policy applies to professional health care providers submitting reimbursement for the Blue Cross and Blue Shield of Texas medical policies and other general reimbursement policies are routinely reviewed. Visit Anthem. CPCP004 NICU Level of Care Authorization and Reimbursement Policy Update Effective 03/06/2024: 12/05/2023: 03/06/2024: CPCP030 Point-of-Care Ultrasound Updated Effective 03/06/2024: 12/05/2023: 03/06/2024: TRS is Moving Requirement of the Consolidated Appropriations Act for plan years on or after Jan. Anesthesia Payment and Billing Update ; Participating Provider Fee Schedule Requests: Professional Providers: See what Blue Cross Blue Shield of Texas plans have to offer you. You can find provider manuals, reimbursement documents and procedures. This amount can be found on the CMS website . Commercial Reimbursement Policy ® Marks of the Blue Cross and Blue Shield Association OBSERVATION, FACILITY Origination: 6/2022 . and the CMS Provider Reimbursement Manual. If a member does not have telemedicine as part of their policy, can they receive telehealth services Effective April 1, 2021, unless otherwise specified in the provider’s agreement, Blue Cross and Blue Shield of Texas (BCBSTX) will align the codes below with the Centers for Medicare and Medicaid Services (CMS) and local Medicare Intermediary reimbursement levels for the Blue Choice PPO SM (including Blue HPN SM), Blue Essentials SM (including HealthSelect SM of 1 . Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, The following resources provide you with the information needed to administer Blue Cross and Blue Shield of Texas (BCBSTX) plans for your patients. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Texas Provider FAQs and COVID-19: FAQs for Medicare Providers . Blue Cross and Blue Shield of North Carolina is an Feb. The Details Under this revised policy BCBSTX will no longer offer additional reimbursement for services based on the use of physical status modifier, P3, P4 and P5, when appended to anesthesia services. Be sure to check to this page often for any changes to your drug list. Providers are encouraged to utilize General Reimbursement Information. 0 Enterprise Clinical Payment and Coding Policy Committee Approval Date: October 31, 2022 Effective Date: February 8, 2023 (Blue Cross and Blue Shield of Texas Only) Description The purpose of this document is to clarify the payment policy for covered psychological and neuropsychological testing. 01/08/2025 Policy Revised on Revenue Codes Requiring Supporting Codes for Outpatient Facility Claims, Effective April 14, 2025. Additional sources are used and can be provided Blue Cross and Blue Shield of Texas (BCBSTX) uses the BCBSTX Provider website to publish disclosure notices. 0 Enterprise Clinical Payment and Coding Policy Committee Approval Date: December 4, 2020 Plan Effective Date: March 18, 2021 (Blue Cross and Blue Shield of Texas Only) Description: The purpose of the Inpatient/Outpatient Unbundling Policy is to provide guidance for covered medical The Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policy manual contains Medical Policies used by Blue Cross Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee Reimbursement Policy Policy Number: CPCP032 Version 1. Fee Schedule Update for BCBSTX DME, Prosthetic and Orthotics Providers Effective March 1, 2023, Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the . Upon request, the provider is urged to submit any additional documentation. The clinical payment and coding guidelines are General Reimbursement Information. If your provider does not send the claim for you, you can file it yourself. 321(b) and the terms of your Network agreement(s), as applicable. When it is determined new policies or updates to existing policies are required Blue Cross and Blue Shield of Texas will implement the policy for initial claims adjudicated on or after the effective date of such policy. Policy Documents. What’s New: Blue Cross and Blue Shield of Texas will be updating its lists of codes requiring prior authorization, for some commercial members, to reflect new, replaced or removed codes. 0 Enterprise Clinical Payment and Coding Policy Committee Approval Date: July 6, 2020 Plan Effective Date: October 10, 2020 (Blue Cross and Blue Shield of Texas Only) Description The Food and Drug Administration (FDA) defines a medical implant as a device or tissue that is Reimbursement Changes and Updates: Prior to January 9, 2023: Reimbursement Changes/Updates As of January 15, 2023: Reimbursement Changes/Updates BCBSTX Relative Values: Assistant Surgery allowable is 16% of the Surgery rate. Actual Policy Documents. Version: 1. Key Point: Our payment policy states that when multiple procedures are performed by the same physician or physician group on the same patient in Blue Cross and Blue Shield of Texas (BCBSTX) increases the maximum allowable standard fee schedule reimbursement for certain outpatient surgery services when performed at in-network Ambulatory Surgery Centers (ASC) for commercial members*. Please note reimbursement may change to reflect these product changes. See below for key points to help you prepare. Forms and Documents. Clinical payment and coding policies (CPCPs) are based on criteria developed using healthcare professionals and industry standard guidelines. The relationship between these vendors and Blue Cross and Blue Shield of Illinois is that of independent contractors. Write your account/member ID number on your check, cashier’s check or money order. 2 12/22/2023. These policies may impact your reimbursement and your patients’ benefits. 0 Enterprise Clinical Payment and Coding Policy Committee Approval Date: 10/04/2019 Plan Effective Date: January 25, 2020 (For Blue Cross and Blue Shield of Texas Only) Description This Clinical Payment and Coding Policy is intended to provide guidance for professional providers Please be advised the reimbursement information being disclosed contains confidential information proprietary to BCBSTX. Medical Policies Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policies are based on scientific and medical research. d/b/a Highmark Blue Cross Blue Shield is an independent Modifiers - Refer to the Clinical Payment and Coding Policy page for the Modifier Reference Guidelines as well as specific service policies. terms, conditions, limitations and exclusions set forth in the member's policy or benefits document. Drug Testing Clinical Payment and Coding Policy. Blue Cross and Blue Shield of Texas has updated with minor revisions as part of its annual review, the CPCP002 Inpatient/Outpatient Unbundling Policy- Facility Clinical Payment and Coding Policy (CPCP) effective March 06, 2024 and posted it to the provider website:. Members should refer to their contract of coverage for more details, including benefits, limitations and exclusions. maximum allowable fee schedule for Blue Choice PPOSM, Blue EssentialsSM (including the Health . Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and The following resources provide you with the information needed to administer Blue Cross and Blue Shield of Texas (BCBSTX) plans for your patients. – 8 p. Policy Number: CPCP008 Version 1. Blue365 is a discount program only for BCBSTX members. Explore employer, individual, family, Medicare and Medicaid options available for you. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield BCBSTX MEDICAL POLICIES AND BCBSTX CLINICAL PAYMENT AND CODING POLICIES. Effective April 1, 2021, unless otherwise specified in the provider’s agreement, Blue Cross and Blue Shield of Texas (BCBSTX) will align the codes below with the Centers for Medicare and Medicaid Services (CMS) and local Medicare Intermediary reimbursement levels for the Blue Choice PPO SM (including Blue Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy Policy Number Effective Date End Date; Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy: CPCP032: 04/30/2024: 10/03/2024: Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy: CPCP032: Effective March 1, 2023, Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the maximum allowable fee schedule for Blue Choice PPO SM, Blue Essentials SM (including the Health Select Network), Blue Premier SM, Blue High Performance, Blue Advantage HMO SM, MyBlue Health and ParPlan networks (collectively referred to as “Networks”) for in-network and reimbursement policies periodically. Manuals. Clinical Payment and Coding Policy Committee Approval Date: August 24, 2021 . 0 Clinical Payment and Coding Policy Committee Approval Date: November 25, 2020 Plan Effective Date: March 3, 2021 (Blue Cross and Blue Shield of Texas Only) Description The purpose of this document is to clarify the payment policy for covered Applied Behavior Analysis (ABA). Revision; Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. These policies may be superseded by state, federal or Centers for Medicare & Medicaid Services (CMS) requirements. Be sure to check eligibility and benefits before rendering service(s) to make sure a procedure is a Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Coding and Reimbursement Policy, located on the Plan’s website. The SBC shows you how you and the plan would The Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policy manual contains Medical Policies used by Blue Cross Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Point-of-Care Ultrasound Examination Policy Policy Number: CPCP030 Version 1. 0 Enterprise Clinical Payment and Coding Policy Committee Approval Date: April 12, 2023 Plan Effective Date: April 20, 2023 (Blue Cross and Blue Shield of Texas Only) Description This policy applies to professional providers (physicians or other Qualified Healthcare Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Prior Authorizations Lists for Designated Groups; Recommended Clinical Review Option; Prior Authorization Exemptions (Texas House Bill 3459) Claims Filing Tips. Blue Cross and Blue Shield of Texas (BCBSTX) has updated the Clinical Payment and Coding Policies (CPCP) page to include an update to the below policies: Medical Record Documentation Guideline Effective 3/10/2020. 0 Clinical Payment and Coding Policy Committee Approval Date: January 30, 2023 Plan Effective Date: May 16, 2023 (Blue Cross and Blue Shield of Texas Only) Description The intent of this policy is to minimize potential waste and/or abuse by providing guidance for We make our reimbursement policies available to health care professionals as part of Anthem's commitment to transparency. These changes are based on updates from Utilization Management prior authorization assessment, Current Procedural Terminology (CPT . g. 0 Enterprise Clinical Payment and Coding Policy Committee Approval Date: July 20, 2021 Plan Effective Date: November . 0 Enterprise Clinical Payment and Coding Policy Committee Approval Date: September 13, 2021 Plan Effective Date: December 29, 2021 (Blue Cross and Blue Shield of Texas Only) Description: This Clinical Payment and Coding policy was created t o serve as a general reference guide for anesthesia services. Blue Cross and Blue Shield of Texas has revised the Clinical Payment and Coding Policy (CPCP) for CPCP010 Anesthesia Information effective Dec. Compound Drug Schedule; Hospital/Ambul. Blue Cross and Blue Shield of Texas (BCBSTX) is implementing changes in the maximum allowable professional and ancillary fee schedules for Blue Choice PPO SM, Blue Essentials SM (including HealthSelect SM of Texas Network), Blue Premier SM, Blue Advantage HMO SM, Blue High Performance Network ®, MyBlue Health SM and PAR Plan networks The following resources provide you with the information needed to administer Blue Cross and Blue Shield of Texas (BCBSTX) plans for your patients. See the Program Rules on the Well onTarget Clinical Payment and Coding Policy Committee Approval Date: December 1, 2021 Effective Date: January 1, 2022 (Blue Cross and Blue Shield of Texas Only) Description The purpose of this policy is to provide an explanation of the Plan’s process for reviewing inpatient reimbursement of stays that later result in a readmission. To help prepare, it may be important to consider your health care needs, including the doctors you What is the amount of reimbursement that CMS has approved for the COVID-19 testing for HCPCS code U0002 and CPT code 87635? The reimbursement amount for HCPCS U0002 and CPT 87635 is $51. Blue Cross and Blue Shield of Texas (BCBSTX) will implement an increase in the maximum allowable fee schedule for procedure code 97151 effective May 1, 2022, General reimbursement information policies and fee schedule information will be posted under COVID-19 Fee Schedule/Reimbursement Update. MCG Health national guidelines and the CMS Provider Reimbursement Manual. CT Value-added products and services may be discontinued or changed at any time and may be subject to geographical availability. Claim Status; Claim Review Process; Interactive Voice Response (IVR) System Clinical Payment and Coding Policy Updates. ----- COVID-19 Fee Schedule/Reimbursement Update Effective April 1, 2021, unless otherwise specified in the provider’s agreement, Blue Cross and Blue Shield of Texas (BCBSTX) will align the codes below with the Centers for Medicare and Medicaid Services (CMS) and local Blue Cross and Blue Shield of Texas Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy: CPCP032: 10/03/2024: 10/04/2024: View Archive: Laboratory Management Policies (Applicable to Certain ASO Groups) March 05, 2024. 0624 Preventive Care Guidelines 2023-2024 Our Preventive Care Guidelines for providers focus on primary preventive services, such as immunizations, education 03/24/2023. BCBSTX Clinical Payment and Coding Policies are based on criteria developed by specialized professional societies, national guidelines (e. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Codes referenced in this policy do not guarantee reimbursement for claims. Changes to this Preventive Services policy are based on compliance with the United States Preventive Services Task Force updates and/or may be the result of American Medical Association procedure code 09/20/2022. Blue Cross and Blue Shield of Texas has updated the Clinical Payment and Coding Policy (CPCP) for CPCP006 Preventive Services Policy effective Jan. 0 Clinical Payment and Coding Policy Committee Approval Date: 11/22/2018 Effective Date: 04/01/2019 (Blue Cross and Blue Shield of Texas Only) Description: This policy is to provide a guideline on the coding and documentation requirements for the reimbursement of Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Prior Authorizations Lists for Designated Groups; Recommended Clinical Review Option; Prior Authorization Exemptions (Texas House Bill 3459) Claims Filing Tips. This includes: Visits to PCPs, specialists (with an OK ahead of 12/15/2023 - Updated 01/08/2024 -See New Notice. 2024 Policy Policy Number: CPCP010 Version: 3. This implementation includes the posting of new Clinical Payment and Coding Policies. NOTICES & ANNOUNCEMENTS . In addition, participating providers can refer to modifier information in the secure content area of the General Reimbursement Information page. You can simply pay the premium for the plan you want to keep, and not pay the premium for the plan you want to cancel and prescription drug benefit coverage with Blue Cross and Blue Shield of Texas (BCBSTX), we will be covering FDA-authorized diagnostic test kits if purchased from an in-network pharmacy. Claim Status; Claim Review Process; Interactive Voice Response (IVR) System Policy Number: CPCP023 Version 2. Commercial Reimbursement Policy ® Marks of the Blue Cross and Blue Shield Association BUNDLING GUIDELINES Origination: 1/2000 Last Review: 11/2024 Description Professional services are identified with Current Procedure Terminology (CPT®) codes, Healthcare Common Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Page 1 of 6 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 22, 2022. yget xcwvsm jcslyv bezq gmgbke awsq ckibwc jpv xfvlero itifl