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Urinary Drug Test (UDT) Fee Schedule Update

October 25, 2016

Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the Urinary Drug Test (UDT) series CPT codes maximum allowable fee schedule used for Blue Choice PPOSM, Blue Premier, Blue Essentials formerly HMO Blue TexasSM, Blue Advantage HMOSM and ParPlan members effective February 1, 2017.

Blue Cross and Blue Shield of Texas (BCBSTX) periodically reviews claims submitted by providers to help ensure that benefits provided are for services that are included in our members’ benefit plans and meet BCBSTX’s guidelines.

BCBSTX provides general reimbursement information policies, fee schedule request forms and fee schedule information under the General Reimbursement Information section. Reimbursement changes and updates will be 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.

Below is a brief description of the change.

Professional claims submitted on a HCFA 1500 for Urinary Drug Test (UDT) 80000 series CPTs and billed with or without the CMS specified G code replacements on the same HCFA 1500 claim, will not be reimbursed by BCBSTX effective February 1, 2017. However, the CMS specified G HCPCS code replacements for the UDT 80000 series codes (see grid below) will be considered for reimbursement according to our fee schedule posted General Reimbursement Information section.

HCPCS Codes

Drug Test Class

G0480

1-7

G0481

8-14

G0482

15-21

G0483

22or more

Please remember that if services are rendered directly by the provider, the services may be billed by the provider. However, if the provider does not directly perform the service and the service is rendered by another provider, only the rendering provider can bill for those services. For additional information, please refer to both the monthly Blue Review Newsletter and Provider Manuals also located on our website under the General Reimbursement Information section. Please be advised that the reimbursement information being disclosed within this notification 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, Blue Choice PPOSM, Blue Premier, Blue Essentials formerly HMO Blue TexasSM, and Blue Advantage HMOSM agreements.

For ancillary provider questions, please feel free to email your questions to bcbstxancillarycontracting@bcbstx.com or if you need additional information, please contact your Network Management Representative