Professional Reimbursement Schedules Effective 7/1/08

Reimbursement Changes and Updates 

Reimbursement Changes/Updates 

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.

Facility Relative Values 

Non-Facility Relative Values 

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.

Clinical Lab 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: 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 

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.

Other Codes Schedule 

Multiple Imaging Procedure Reduction – Technical Component  

Multiple Procedure Reduction of the Technical Component (TC) of Certain Diagnostic Imaging Procedures