Behavioral Health Mid-Level Fee Schedule Increase - Blue Cross Medicare Advantage (PPO)^SM, Blue Cross Medicare Advantage (HMO)^SM and Blue Cross Medicare Advantage Dual Care (HMO SNP)^SM

10/11/2023

Blue Cross Blue Shield of Texas (BCBSTX) is pleased to announce a significant development concerning reimbursement rates for Behavioral Health (BH) mid-level providers; effective January 1, 2024. The rate increase will be implemented for the services of the below BH mid-level providers, aligning them with 100% of the Medicare fee schedule, by the applicable specialty:

This decision reflects BCBSTXs’ commitment to recognizing the invaluable contributions of healthcare providers and their essential role in delivering exceptional care to our Medicare Advantage members.

Fee schedule links are available via Availity® by selecting the Claims & Payments menu, Fee Schedule Listing, and then choose the appropriate Additional Fee Schedules for Medicare.

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 at no cost.

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

If you are not yet registered:

1. Sign up today at Availity, at no charge. If you need registration assistance, contact Availity Client Services at 1-800-282-4548.
2. For navigational assistance, refer to the Availity Fee Schedule User Guide.
3. Note: If you do not have Availity access, you may continue to submit your requests using the Professional Fee Schedule Request forms located on our provider website.

Providers with questions or in need of further clarification regarding this rate adjustment are encouraged to contact your dedicated Medicare Advantage Representative .

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, endorsement, representations, or warranties regarding third party vendors and the products and services they offer.