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Pass-Through Billing

Pass-through billing occurs when the ordering physician, professional provider, facility, or ancillary provider requests and bills for a service, but the service is not performed by the ordering physician, professional provider, ancillary of facility provider. The performing physician, professional provider, facility or ancillary provider is required to bill for the services they render unless otherwise approved by BCBSTX.

BCBSTX does not consider the following scenarios to be pass-through billing:

  1. The service of the performing physician, professional provider, facility or ancillary provider is performed at the place of service of the ordering physician or professional provider and is billed by the ordering physician or professional provider, or
  2. The service is provided by an employee of a physician, professional provider, ancillary or facility provider, i.e. physician assistant, surgical assistant, advanced practice nurse, clinical nurse specialist, certified nurse midwife and registered first assistant, who is under the direct supervision of the ordering physician or professional provider and the service is billed by the ordering physician or professional provider.

Should you have any questions, please contact your local Professional Provider Network or Facility Provider Network office.