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Revised Effective Dates for Fee Schedule Updates for Applied Behavior Analysis (ABA) and Related Services for Blue Choice PPOSM and ParPlan

December 27, 2016

On 10/17/2016, Blue Cross and Blue Shield of Texas (BCBSTX) notified providers of changes in the maximum allowable fee schedule used for Blue Choice PPO and ParPlan for Applied Behavior Analysis (ABA) and related services. The effective dates for some of these changes have been postponed as noted below.

Brief descriptions of the changes:

  • Effective February 1, 2017, the fee schedule for CPT codes 0359T, 0370T, 0360T and 0361T specific for Applied Behavior Analysis and related services will be updated.
  • Effective April 1, 2017 (not February 1, 2017), the fee schedule for CPT codes 0368T, 0369T, 0371T, 0372T, 0362T, 0363T, 0364T, 0365T, 0366T, 0367T, 0373T and 0374T will be updated.
  • Effective April 1, 2017 (not February 1, 2017), the payable units for the following codes 0359T, 0370T, 0371T and 0372T will be updated to be limited to one unit per day.
  • Effective February 1, 2017, 0359T will be limited to two assessments per twelve-month period.

The fee schedule changes for Blue Choice PPO are located under the General Reimbursement Information, section of the Standards and Requirements tab on the bcbstx.com Provider website.

BCBSTX also provides general reimbursement information policies, fee schedule request forms and fee schedule information under the General Reimbursement Informationsection of the Standards and Requirements tab on our website. Additionally, reimbursement changes and updates are posted under "Reimbursement Changes/Updates" in the Professional Reimbursement Schedules section. The changes will become effective 90 days from the posting date. The specific effective date will be noted for each change that is posted.

Please be advised that this reimbursement information contains confidential information proprietary to BCBSTX. The use and disclosure of this information is restricted under Texas Insurance Code Section 1301.136(b), Texas Insurance Code Section 843.321(b) and the terms of your BCBSTX agreements If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.