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Evidence Based Reimbursement

Effective December 15, 2009, Blue Cross and Blue Shield of Texas (BCBSTX) will begin reimbursing for the following Performance Management CPT codes:

Category II Code
Description
Frequency
0500F Initial prenatal care visit As appropriate
0501F Prenatal flow sheet documented in medical record by first prenatal visit As appropriate
1034F Current tobacco smoker (CAD, CAP, COPD, PV) (DM) Annual
1035F Current smokeless tobacco user (eg, chew, snuff) (PV) Annual

These codes facilitate data collection about quality of care. They allow physicians to report services based on nationally established, evidence-based performance guidelines for improving quality of patient care. The codes will provide us with information unavailable from claims data.

  • Codes 1034F and 1035F identify tobacco users.
  • Initial prenatal care visit codes (0500F and 0501F) identify maternity cases.

Use of these codes should allow us to increase referrals to the Lifestyle Management Program and to Special Beginnings®, the BCBSTX maternity program designed to offer support and education from prenatal to postpartum care.

We encourage physicians to report these codes. Reimbursing these codes supports the BCBSTX goal of improving the health of the population and our focus on wellness.

Note: When billing codes 0500F, 0501F 1034F, and 1035F, submit your usual charge. Please do not submit the codes with a $0 charge.