03/29/2024
Blue Cross and Blue Shield of Texas has revised the Clinical Payment and Coding Policy (CPCP) for the CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) effective April 1 and May 15, 2024. The policies may contain codes recently added/replaced by CMS or codes that were previously EIU but now may be a covered service per BCBSTX Medical Management. The revised versions have been posted on the provider website. The changes to the May 15 version are only to incorporate the changes for April 1.
- CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) Effective 04/01/2024
- CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) Effective 05/15/2024
Be sure to check eligibility and benefits before rendering service(s) to make sure a procedure is a covered benefit for the member and whether it requires a prior authorization or may need a recommended clinical review. Refer to Clinical Payment and Coding Policies under Standards and Requirements on the provider website to review the current CPCPs.
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.