Fee Schedule Update

March 28, 2014

Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the maximum allowable fee schedule used for Blue Choice PPOSM, HMO Blue TexasSM, Blue Advantage HMOSM (Independent Provider Network and THE Limited Network only), and ParPlan effective July 1, 2014.

  • The methodology used to develop the maximum allowable fee schedule for Blue Choice PPO and HMO Blue Texas will be based on 2014 CMS values posted on the CMS website as of January 31, 2014 for those services for which the BCBSTX reimbursement is based on CMS values. 
  • The methodology used to develop the maximum allowable fee schedule for Blue Advantage HMO will be based on BCBSTX weights posted on the website. 
  • Geographic Practice Cost Indices (GPCIs) will not be applied to the relative values so the relative values will not differ by Medicare locality. 
  • HMO Blue Texas, Blue Choice PPO, and ParPlan relative values and Blue Advantage HMO weights will consider the site of service where the service is performed (facility or non-facility).
  • Effective June 1, 2014, BCBSTX will revise the methodology utilized for determining the allowables for CPT and HCPCS codes associated with multiple National Drug Codes (NDCs), including immunizations. The HCPCS or CPT code allowable generally will be equivalent to the lowest NDC allowable associated with the HCPCS or CPT code.
  • The CPT/HCPCS Fee Schedule will be updated quarterly on March 1, June 1, September 1 and December 1 each year. 
  • The NDC Fee Schedule will be updated monthly.
  • Effective July 1, 2014, if Physical Status Modifiers  P3, P4 or P5 are billed, the full unit value for these Physical Status Modifiers will be reimbursed even if the obstetrical delivery total maximum allowable points have been met.

Blue Cross and Blue Shield of Texas provides general reimbursement information policies, request forms for allowable fees and fee schedule information. To view this information, visit the General Reimbursement Information section on the website. If you would like to request a sample of maximum allowable fees or if you have any other questions, please contact your Provider Relations office.

Reimbursement changes will be posted under "Reimbursement Changes/Updates" in the Professional Reimbursement Schedules section on the BCBSTX Provider website. 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.