Reimbursement Percentage Update for Modifier 52 - Clarification

November 27, 2017

On October 20, 2017, Blue Cross and Blue Shield of Texas (BCBSTX) notified providers that it will implement changes to the reimbursement percentage for Modifier 52 (Reduced Services) effective February 1, 2018.To further clarify, this change effects professional providers only.

The modifier reimbursement percentages are located on the provider website under General Reimbursement Information.

Brief description of the change:

  • Effective February 1, 2018, the reimbursement percentage for Modifier 52 (Reduced Services) will be 50% of the allowable services.

BCBSTX provides general reimbursement information policies, fee schedule request forms and fee schedule information under the General Reimbursement Information section 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 not become effective until at least 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.