Multiple Surgery Pricing Per Session Methodology - Update
Effective July 1, 2010, Blue Cross and Blue Shield of Texas (BCBSTX) will implement a “per operative session” methodology for Multiple Surgery Pricing. BCBSTX currently uses an “operative area” methodology.
The change to a “per operative session” Multiple Surgery pricing methodology means the primary surgical procedure will be adjudicated at 100% of the allowed amount and each subsequent surgical procedure performed (regardless of anatomic area) will be adjudicated at 50% of the allowed amount. The procedure with the highest dollar allowance will be considered the primary procedure.
Note: Add-on codes, Modifier-51 exempt codes, and codes related to skin lesion removal and fracture care will continue to be exempt from Multiple Surgery pricing logic.