Multiple Surgery Pricing Per Session Methodology - UPDATED

Effective July 1, 2010, BCBSTX implemented a “per operative session” methodology for Multiple Surgery Pricing.

The change to a “per operative session” Multiple Surgery Pricing methodology means the primary surgical procedure will be adjudicated at 100% of the allowable amount and each subsequent surgical procedure performed (regardless of anatomic area) will be adjudicated at 50% of the allowable amount.  The service line with the highest dollar allowance will be considered the primary service/procedure.

Effective January 31, 2011, BCBSTX will apply Multiple Surgery Pricing per session methodology to:

  • CPT code 30520
  • Bilateral surgical procedures [defined by AMA as surgical procedures performed on identical anatomic sites, aspects, or organs (i.e. hands, feet, ears)] which means bilateral surgical procedures will be priced at 150% of the allowable amount.

The service line with the highest dollar allowance will be considered the primary service/procedure. Each subsequent surgical procedure performed (regardless of anatomic area, site, aspects, or organs) will be adjudicated at 50% of the allowable amount.

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.

View guidelines for claim submissions prior to Jan. 31, 2011.