BlueChoice and HMO Blue Texas Schedules – Effective 11/1/12

Reimbursement Changes and Updates

 

Reimbursement Changes/Updates

 

BCBSTX Relative Values

Assistant Surgery allowable is 16 % 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, Other Lab, Durable Medical Equipment/Prosthetics and Orthotics. Drugs, Clinical Lab, Other 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

 

Lab

Professional component for procedures listed on the Lab Schedules will be reimbursed at $5 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

Other Lab Codes 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: 9/1/2012, 12/1/2012, 3/1/2013, and 6/1/2013.

Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount.

 

CPT/HCPCS Drug Schedule

 

Other Codes

Assistant Surgery allowable is 16% 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, Other Lab, Durable Medical Equipment/Prosthetics and Orthotics. Drugs, Clinical Lab, Other 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