Professional Reimbursement Schedules

Effective 9/01/04


Please select from the links below:

BCBSTX Relative Values for Medical Care Providers including Physician Assistants, Advance Nurse Practitioners, Registered Nurse First Assistants, Licensed Surgical Assistants, Clinical Nurse Specialists, Nurse Midwives

Multiply your conversion factors and the relative values below to determine your reimbursement maximums.
For all schedule representation, modifier 80 was used. Please see the medical policy link for additional modifier information.

  BCBSTX Relative Values 

Provider Areas to use for Medical Care Provider Relative Value File

Provider County
BCBS Provider Area Reference
Brazoria
20
Dallas, Tarrant, Collin
57
Galveston
84
Harris
101
Jefferson
123
Travis
227
All Other Counties
999

Behavioral Health Specialists

  Psychologist 
  Psychiatrist 
  Licensed Professional Counselor, Licensed Psychological Associate, Licensed Marriage and Family Therapist, Licensed Chemical Dependency Counselor, and Social Worker 

Allied Practitioners
(Schedule applies to both HMO and PPO business)

  Allied Specialties 
  • Chiropractor
  • CRNA
  • Occupational Therapist
  • Audiologist
  • Physical Therapist
  • Speech Pathologist
  • Optometrist
  • Oral Pathologist

Clinical Laboratory

  Clinical Laboratory 

Durable Medical Equipment/ Prosthetics and Orthotics

  Durable Medical Equipment/ Prosthetics and Orthotics Schedule 

Drugs

  HMO 
  PPO 

Other Codes

Schedule to determine maximum reimbursement for codes not defined above other than “Not Otherwise Classified” codes.

Pricing increases have been made to the PET scan codes (G0030 - G0296) and the immunization codes (90281 - 90788) that will be effective for the 9/1/2004 update. Please see the attached schedules for the new rates on the marked codes.

 

Medical Care Providers excluding Physician Assistants, Advance Nurse Practitioners, Registered Nurse First Assistants, Licensed Surgical Assistants, Clinical Nurse Specialists, Nurse Midwives

HMO 
PPO 

Physician Assistants, Advance Nurse Practitioners, Registered Nurse First Assistants, Licensed Surgical Assistants, Clinical Nurse Specialists, Nurse Midwives

  HMO 
  PPO 

If you have questions on the material on this Web site, please contact your local Professional Provider Network department.