Home Health Physician Fee Schedule Increase for Medicare Advantage PPO^SM Providers

Effective January 1, 2023, Blue Cross and Blue Shield of Texas (BCBSTX) will add new reimbursement rates to your existing Medicare Advantage PPO agreement fee schedule. After January 1^st, Home Health providers should utilize these Current Procedural Terminology (CPT^®) billing codes for Medicare Advantage PPO members who have Private Duty Nursing as a covered benefit and will be reimbursed as follows:

Fee schedule links are available by selecting the Claims & Payments menu, Fee Schedule Listing, and then choose the appropriate Additional Fee Schedules for Medicare. They can also be found via the Resources tab in the BCBSTX-branded Payer Spaces section in the Availity^® Essentials portal.

How to Use the Availity Fee Schedule Listing Tool:
Note: Availity Administrators must assign the “Provider Fee Schedule” role for users to gain access to this tool.

• Log in to Availity
• Select Claims & Payments from the navigation menu
• Select Fee Schedule Listing
• Select BCBSTX as the payer
• Select your organization and Tax ID number
• Enter the Billing National Provider Identifier (NPI) and Rendering NPI (if applicable)
• Select the Network, Place of Service, and Provider
• Enter the procedure code(s) and modifier(s)

You must be registered with Availity to use the new Fee Schedule tool. You can sign up today at no charge. For registration assistance, call Availity Client Services at 1-800-282-4548. If you do not have online access, you may continue to submit your requests using the Professional Fee Schedule Request form located on our provider website.

If you have any questions or need additional information, please contact your BCBSTX Medicare Network Management Representative.

The material presented here is for informational/educational purposes only, is not intended to be medical advice or a definitive source for coding claims and is not a substitute for the independent medical judgment of a physician or other health care provider. Health care providers are encouraged to exercise their own independent medical judgment based upon their evaluation of their patients’ conditions and all available information, and to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.

CPT copyright 2022 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.