Fee Schedule Update for ParPlan, BlueChoice® and HMO Blue® Texas Ancillary Providers

The ParPlan, BlueChoice® and HMO Blue® Texas maximum allowable fees for all Ancillary Providers will be updated to reflect 2011 relative values effective September 1, 2011.

  • HMO Blue Texas, BlueChoice, and ParPlan relative values will consider the site of service where the service is performed (facility or non-facility).

  • A multiple procedure payment reduction will be made on the technical component (TC) of certain diagnostic imaging procedures. The reduction applies to TC only services and the TC portion of global services for the procedures listed on the website. The reduction does not apply to professional component (26) services. 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 50% of the allowable. In addition, the 11 families of imaging procedures will be consolidated into one family.

  • Blue Cross and Blue Shield of Texas (BCBSTX) currently accepts NDC for billing of all drugs and contrast materials. Effective December 1, 2011 BCBSTX will begin reimbursing claims submitted with an NDC in accordance with the NDC schedule posted on the website under "Drugs." Including the NDC on claims helps provide a more consistent pricing methodology for payment and will also facilitate better management of drug-associated costs. Facilities are encouraged to include the NDC information on claims as soon as possible. For information about how to add the additional NDC and other required elements, please refer to the BCBSTX Provider website at www.bcbstx.com/provider. BCBSTX will continue to accept the HCPCS or CPT code elements without NDC information (excluding unlisted or "Not Otherwise Classified" drugs).

  • The Drug CPT/HCPCS Fee Schedule will be updated on the following dates: 6/1/2011, 9/1/2011, 12/1/2011, 3/1/2012 and 6/1/2012.

BCBSTX provides general reimbursement information policies, a professional fee schedule online request form for allowable fees, and other fee schedule information at www.bcbstx.com/provider. To view this information, visit the General Reimbursement Information section on this website.

Reimbursement changes will be posted under "Reimbursement Changes and 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.

If you have any questions, please contact your Facility Provider Network representative.