When performing surgical procedures in a non-facility setting, the physician's and other professional provider's reimbursement is all-inclusive. The Blue Cross and Blue Shield of Texas (BCBSTX) payment covers all the services, supplies, and equipment needed to perform the surgical procedure when a member receives these services in the physician's and other professional provider's office. Reimbursement will be allowed for some supplies billed in conjunction with a surgical procedure performed in the physician or professional provider’s office.
Please note the physician and other professional provider reimbursement includes surgical equipment which may be owned or supplied by an outside surgical equipment or Durable Medical Equipment (DME) vendor. Claims from the surgical equipment or Durable Medical Equipment (DME) vendor will be denied since the global physician and other professional provider reimbursement includes staff, supplies and equipment.
To help determine how coding combinations on a claim may be evaluated during the claim adjudication process, you may continue to utilize Clear Claim ConnectionTM (C3). C3 is a free, online reference tool that mirrors the logic behind BCBSTX’s code-auditing software. Refer to the Provider website for additional information on gaining access to C3.