Fee Schedule Update
Blue Cross and Blue Shield of Texas (BCBSTX) implemented changes in the maximum allowable fee schedule used for Blue Choice PPOSM, Blue EssentialsSM, Blue PremierSM, Blue Advantage HMOSM and ParPlan effective October 1, 2017. The changes were disclosed in letters mailed to providers as of 06/30/2017 and also included in the July, August and September 2017 Blue Review newsletters.
- The methodology used to develop the maximum allowable fee schedule for Blue Choice PPO, Blue Essentials, Blue Premier, Blue Advantage HMO and Par Plan will be based on 2017 CMS values as posted on the website for those services for which the BCBSTX reimbursement is based on CMS values.
- BCBSTX provides general reimbursement information policies, fee schedule request forms and fee schedule information at bcbstx.com/provider. To view this information, visit the General Reimbursement Information section on this website. Reimbursement changes and updates will be posted under "Reimbursement Changes/Updates" in the Reimbursement Schedules section. The specific effective date will be noted for each change that is posted.
- Blue Choice PPO, Blue Essentials, Blue Premier and Blue Advantage HMO will consider the site of service where the service is performed.
- The conversion factor for certain surgical codes may vary by place of service for ambulatory surgical center and outpatient hospital.
- For BlueChoice PPO, Blue Essentials, Blue Premier and Blue Advantage HMO, the multiple procedure payment will be changing on the professional component of certain diagnostic imaging procedures. This change applies to services billed as professional component only or global for the procedures listed on the website. The highest priced procedure will be reimbursed at 100% of the allowable and each additional procedure, when performed during the same session on the same day, will be reimbursed at 95% (previously 75%) of the allowable.
If you would like to request a sample of maximum allowable fees or if you have any other questions, please contact your Network Management office.