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Fee Schedule Update for Blue Choice PPOSM and ParPlan for Applied Behavior Analysis and Related Services

October 17, 2016

Effective Feb. 1, 2017, Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the maximum allowable fee schedule used for Blue Choice PPO and ParPlan for Applied Behavior Analysis (ABA) and related services.

The fee schedule changes for Blue Choice PPO are located under General Reimbursement Information.

Brief descriptions of the changes:

  • Effective Feb. 1, 2017, the fee schedule for CPT codes 0359T-0374T specific for Applied Behavior Analysis and related services will be updated.

  • The payable units will be limited to one unit per day for the following codes: 0359T, 0370T, 0371T and 0372T.

  • Additionally 0359T will be limited to two assessments per 12-month period.

BCBSTX also 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.