Pass-through billing is not permitted by BCBSTX. Pass-through billing occurs when the ordering provider requests and bills for a service, but the service is not performed by the ordering provider. The performing provider should bill for these services unless otherwise approved by BCBSTX.
BCBSTX does not consider the following scenarios to be pass-through billing:
- The service of the performing provider is performed at the place of service of the ordering provider and is billed by the ordering provider, or
- The service is provided by an employee of a physician & other professional provider, e.g. physician assistant, surgical assistant, advanced practice nurse, clinical nurse specialist, certified nurse midwife and registered first assistant, who is under the direct supervision of the ordering provider and the service is billed by the ordering provider.
Should you have any questions, please contact your local Professional Provider Network or Facility Provider Network office.