| Professional Reimbursement Schedules Effective 7/1/08 |
| Reimbursement Changes and Updates |
Reimbursement Changes/Updates
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| BCBSTX Relative Values |
Assistant Surgery allowable is 20% 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, Durable Medical Equipment/Prosthetics and Orthotics. Drugs, Clinical Lab, Durable Medical Equipment/ Prosthetics and Orthotics will be reimbursed at 100% of the rates posted on the internet.
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Facility Relative Values
Non-Facility Relative Values
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| Clinical Laboratory |
Professional component for procedures listed on the Clinical Lab Schedule 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.
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Clinical Lab Schedule
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| Durable Medical Equipment/Prosthetics and Orthotics |
| Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount. |
DME Schedule
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| Drugs |
Note: The Drug/Injectable Fee Schedule will be updated on the following dates: 6/1/2008, 9/1/2008, 12/1/2008, 3/1/2009 and 6/1/2009.
Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount.
Drug Schedule
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| Other Codes |
Assistant Surgery allowable is 20% 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, Durable Medical Equipment/Prosthetics and Orthotics. Drugs, Clinical 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.
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Other Codes Schedule
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| Multiple Imaging Procedure Reduction – Technical Component |
Multiple Procedure Reduction of the Technical Component (TC) of Certain Diagnostic Imaging Procedures
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