Update of CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services Update  for 04/01/2023 & 07/01/2023 

Posted 06/01/2023

We have revised the Clinical Payment and Coding Policies (CPCP) for CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) that are effective April 1, 2023 and July 1, 2023.

During the COVID- 19 Public Health Emergency (PHE) certain codes may have been covered. Now that the PHE has ended, these codes are designated as Non-Reimbursable, Experimental, Investigational and/or Unproven Services (EIU) and have been added effective June 1, 2023, to the April 1 and July 1 versions of the CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) policies.

In addition, for the July 1, 2023 EIU policy, some codes were removed from the previously posted policy and will not be effective until Sept. 1. There were also some procedure codes added by CPT® effective 07/01/2023 and they are considered EIU codes and have been added to the 07/01/2023 policy.

Refer to Clinical Payment and Coding Policies under Standards and Requirements on the provider website to review the updated 04/01/2023 and 07/01/2023 policies

Be sure to check eligibility and benefits before rendering service(s) to make sure a procedure is a covered benefit for the member.

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

Clinical payment and coding policies are based on using healthcare professionals and industry standard guidelines. The clinical payment and coding guidelines are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.