Independent Lab/Sleep Lab — Reimbursement Schedules Effective 11/1/12

Reimbursement Changes and Updates 

Reimbursement Changes/Updates 

BCBSTX Relative Values 

Assistant Surgery allowable is 16% of the Surgery rate. Physician Assistants, Advance Nurse Practitioners, Registered Nurse First Assistants, Licensed Surgical Assistants, Clinical Nurse Specialists and Nurse Midwives will be reimbursed 85% of the rates posted on the internet except for Drugs, Clinical Lab, Other Lab, Durable Medical Equipment/Prosthetics and Orthotics. Drugs, Clinical Lab, Other Lab, Durable Medical Equipment/ Prosthetics and Orthotics will be reimbursed at 100% of the rates posted on the internet.

Facility Relative Values 

Non-Facility Relative Values 

Lab 

Professional component for procedures listed on the Lab Schedules will be reimbursed at $5.00 for HMO and $5.50 for PPO.

Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount.

Clinical Lab Schedule 

Other Lab Codes Schedule 

Durable Medical Equipment/Prosthetics and Orthotics 

Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount.

DME Schedule 

Drugs

Note: The Drug/Injectable Fee Schedule will be updated on the following dates: 9/1/12, 12/1/2012, 3/1/2013 and 6/1/2013.

Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount.

CPT/HCPCS/Drug Schedule 

Other Codes 

Assistant Surgery allowable is 16% of the Surgery rate.

Physician Assistants, Advance Nurse Practitioners, Registered Nurse First Assistants, Licensed Surgical Assistants, Clinical Nurse Specialists and Nurse Midwives will be reimbursed 85% of the rates posted on the internet except for Drugs, Clinical Lab, Other Lab, Durable Medical Equipment/Prosthetics and Orthotics. Drugs, Clinical Lab, Other Lab, Durable Medical Equipment/ Prosthetics and Orthotics will be reimbursed at 100% of the rates posted on the internet.

Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount.

Other Codes Schedule 


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