General Reimbursement Information

Reimbursement Schedules and Related Information

Professional

• Blue Choice PPO^SM, Blue Essentials^SM, Blue Premier^SM, Blue Advantage HMO^SM, MyBlue Health^SM, Blue High Performance^SM Schedules
• Schedule Request

Compound Drugs

• Compound Drug Schedule

Hospital/Ambul. Surg Ctr./Endoscopy Ctr.

• Hospital Schedules
• Ambulatory Surg Ctr./Endoscopy Ctr. Schedules
• Reference Material

Rehabilitation Facility/LTAC/SNF/Acquired Brain Injury

• Specialty DME Schedule

Ancillary

• Ambulance
• Durable Medical Equipment/Prosthetics & Orthotics
• Home Health Schedules
• Home Infusion Therapy Schedule
• Imaging/Radiation Therapy Centers
• Independent Lab/Sleep Lab

Ancillary/Hospital Fee Schedule Request

• Ancillary/Hospital Fee Schedule Request

All Product News

Assistant at Surgery Logic

Modifier Reimbursement

• Effective 2/1/24
• Effective 2/1/18 - 1/31/24
• Effective 11/1/15 - 1/31/18
• Effective 7/1/14 - 10/31/15
• Effective 11/1/13 - 6/30/14
• Effective 11/1/12 - 10/31/13

Modifiers — Prof. Claims

Molecular Pathology Procedure Test Codes

Multiple Imaging Procedures Reduction

• Effective 3/1/20
• Effective 10/1/17 — 2/29/20

Multiple Procedure Payment Reduction

• Effective 3/1/20
• Effective 7/1/18 — 2/29/20

Multiple Surgery — Prof

• Effective through 6/30/10
  

Procedure Plus an Evaluation and Management Service

• Effective 9/1/11

Texas HMO Outpatient Clinical Reference Lab

Services                                                                  

Effective 01/01/2022

All Plan providers should refer members to in-network lab providers for outpatient lab services. To locate participating labs in the Plan network, visit Provider Finder^® on the BCBSTX website.

Refer to Provider Finder^® for participating clinical laboratory providers.

Effective 09/01/2020-12/31/2021

For HMO physicians and other professional providers located in counties on the HMO Reimbursable Lab County Listing, lab services on the Reimbursable Lab Services List will be reimbursed on a fee-for-service basis if performed in the physician's or professional provider’s office. All other lab services for HMO members must be sent to a participating lab.

Statewide in-network clinical labs for HMO members include the following as of Sept. 1, 2020:

• Clinical Pathology Laboratory (CPL) — contact CPL at 1-800-595-1275 or visit CPL's website.
• LabCorp - contact LabCorp at 1-888-522-2677 or visit LabCorp's website.
• Quest Diagnostics, Inc. — contact Quest at 1-888-277-8772 or visit Quest's website.

Refer to Provider Finder^® for additional participating clinical laboratory providers.