Disclosure Notices

Blue Cross and Blue Shield of Texas (BCBSTX) uses the BCBSTX Provider website to publish disclosure notices. The website allows BCBSTX to disclose changes in a timely and comprehensive manner.

Disclosure notices are subject to being posted either 60 or 90 days in advance of the effective date of the change with as much notice as is practicable and in compliance with applicable state or federal law.

Disclosure notices can include but are not limited to fee schedule updates and reimbursement policies, clinical payment and coding policies, provider manuals and/or benefit and medical policy changes which may impact claim payments.

If you need assistance accessing this information on the BCBSTX Provider website, please contact your Network Management office.

Note - Effective Feb. 1. 2021, disclosures related to Clinical Payment and Coding Policies (CPCP) will indicate CPCP and the policy number followed by the title of the policy.

2021

Notice	Posted	Effective
Multiple Procedure Payment Reduction Claims Review	03/01/2021	06/01/2021
CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)	02/09/2021	05/15/2021
Telehealth Claim Place of Service	01/29/2021	05/01/2021

2020

Notice	Posted	Effective
Preventive Services Clinical Payment and Coding Policy Update	01/14/2021	01/15/2021
Clinical Payment and Coding Policy Updates - 12/30/2020	12/30/2020	02/12/2021
Clinical Payment and Coding Policy Updates - 12/30/2020	12/30/2020	01/01/2021
Clinical Payment and Coding Policy Update - 12/29/2020	12/29/2020 Correction 2/15/2021	04/05/2021
Preventive Services Clinical Payment and Coding Policy Update	12/29/2020	01/01/2021
Clinical Payment and Coding Policy Update - 12/29/2020	12/29/2020	04/01/2021
Update to Prior Authorization Codes for Commercial Members	12/24/2020	04/01/2021
COVID-19 Fee Schedule/Reimbursement Update - 12/23/2020	12/23/2020	04/01/2021
Tiered Payment Rate Modifiers for ABA Effective April 1, 2021	12/21/2020	04/01/2021
Clinical Payment and Coding Policy Update - 12/14/2020	12/14/2020	03/18/2021
Clinical Payment and Coding Policy Update - 12/02/2020	12/02/2020	03/03/2021
Clinical Payment and Coding Policy Update - 11/19/2020	11/19/2020	02/25/2021
Telemedicine and Telehealth Clinical Payment and Coding Policy Update Including Change to Code Q3014	11/12/2020	02/12/2021
Clinical Payment and Coding Policy Update - 11/05/2020	11/05/2020	02/10/2021
Clinical Payment and Coding Policy Update - 11/03/2020	11/03/2020	03/01/2021
Update to Prior Authorizations – Jan. 1, 2021	10/29/2020	01/01/2021
New Prior Authorization Lists for Blue Cross Medicare Advantage℠ January 1, 2021	10/13/2020	01/01/2021
Clinical Payment and Coding Policy Update	10/07/2020	01/10/2021
Telemedicine and Telehealth Clinical Payment and Coding Policy Update	10/02/2020	01/01/2021
Clinical Payment and Coding Policy Update	10/01/2020	01/01/2021
Preventive Services Clinical Payment and Coding Policy Update	09/28/2020	10/01/2020
Prior Authorization Expansion to AIM^®	09/28/2020	01/01/2021
Itemized Bills Required for BlueCard^® Facility Claims over $100K	09/28/2020	01/01/2021
Introducing the Blue High Performance Network^SM (Blue HPN)^SM	09/23/2020	01/01/2021
Clinical Payment and Coding Policy Updates	09/18/2020	12/28/2020
Clinical Payment and Coding Policy Updates	09/01/2020	12/01/2020
Update - Physician Efficiency, Appropriateness, and Quality (PEAQ) Program Methodology	08/20/2020	09/01/2020
Correction -Clinical Payment and Coding Policy Update	08/14/2020	09/01/2020
Clinical Payment and Coding Policy Updates	08/07/2020	11/10/2020
Clinical Payment and Coding Policy Updates	07/09/2020	10/10/2020
Update: Behavioral Health Program Changes for HealthSelect of Texas^® - Sept.1	07/01/2020	09/01/2020
Procedure Code Updates for Prior Authorization	06/29/2020	09/01/2020
Preventive Services Clinical Payment and Coding Policy Update	06/29/2020	07/01/2020
CPCP018 Revenue Codes Requiring CPT or HCPCS Codes Update	06/29/2020	07/01/2020
AIM Specialty Health^® (AIM) to Perform Utilization Management	06/26/2020	09/01/2020
Clinical Payment and Coding Policy Updates	06/08/2020	09/15/2020
Blue Cross Medicare Advantage Prior Authorization Updates effective Sept. 1, 2020	06/03/2020	09/01/2020
Prior Authorization Code Changes for Administrative Services Only Members	06/02/2020	04/20/2020
Clinical Payment and Coding Policy Updates	05/29/2020	09/01/2020
eviCore^® Prior Authorization Code Changes Effective April 20, 2020	05/22/2020	04/20/2020
Clinical Payment and Coding Policy Updates	05/09/2020	08/15/2020
2 Clinical Payment and Coding Policy Updates	04/20/2020	07/20/2020
Behavioral Health Program Changes for HealthSelect of Texas^® - Sept.1	04/15/2020	09/01/2020
3 Clinical Payment and Coding Policy Updates	04/07/2020	07/10/2020
Preventive Services Clinical Payment and Coding Policy Update	03/31/2020	04/01/2020
Clinical Payment and Coding Policy Update Inpatient Readmissions	03/18/2020	06/20/2020
Clinical Payment and Coding Policy Updates	03/10/2020	06/15/2020
Three New ClaimsXten^TM Rules to be Implemented June 2020	02/20/2020	06/15/2020
Behavioral Health Program Changes for Some Provider Networks	02/19/2020	06/01/2020
Drug Testing Clinical Payment and Coding Policy	01/30/2020	05/01/2020
Two New ClaimsXten^TM Rules to be Implemented in 2020	01/20/2020	04/20/2020
Preventive Services Policy	01/08/2020	01/01/2020

2019

Notice	Posted	Effective
Availity Authorization Tool via Availity^® and the Deactivation of iExchange	01/03/2020	04/15/2020
Physician Efficiency, Appropriateness, and Quality (PEAQ) Program Methodology	12/27/2019	01/01/2020
Fee Schedule Update March 1, 2020	12/01/2019	03/01/2020
Blue Cross Medicare Advantage 30 Day Readmission	11/26/2019	03/01/2020
Clinical Payment and Coding Policies E&M Coding Professional Provider & Emergency Dept. Services E&M Coding – Facility Services.	10/24/2019	01/25/2020
Blue Cross Medicare Advantage 2020 New Prior Authorization Requirements	10/01/2019	01/01/2020
Clinical Payment and Coding Policies Updates	09/27/2019	01/01/2020
Itemized Bills Required for BlueCard^® Claims Over $200k	09/27/2019	01/01/2020
2020 New Prior Authorization Requirements and Introduction of MyBlue Health^SM	09/25/2019	01/01/2020
Update to Clinical Payment and Coding Policy – Chiropractic Services	09/03/2019	12/03/2019
New Clinical Payment and Coding Policy	08/01/2019	11/01/2019
Updates to 3 Clinical Payment and Coding Policies	07/25/2019	10/25/2019
City Of Austin Member Preauthorization Changes	06/19/2019	01/01/2019
Change for American Airlines Members to Preauthorization Requirements for Spinal Fusion Surgery Procedures to eviCore	05/01/2019	08/01/2019
Revised Clinical Payment and Coding Policies	05/01/2019	08/01/2019
New Genetic Testing and Revised Sleep Study Preauthorization Requirements for H-E-B Partners with Blue Choice PPO^SM	Updated-07/31/2019 Original -04/29/2019	08/31/2019
Clinical Payment and Coding Policy – Laboratory Panel Billing Guideline	04/16/2019	07/18/2019
Revised Texas Clinical Payment and Coding Policy – Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy	04/12/2019	07/15/2019
Revised Texas Clinical Payment and Coding Policy – Telemedicine and Telehealth Services	03/28/2019	07/01/2019
New Texas Clinical Payment and Coding Policy – Trauma Activation	03/28/2019	07/01/2019
Transferring Hospital DRG Rate Calculation and Discharge Status Code Addition	03/22/2019	07/15/2019
New Clinical Payment and Coding Policy - Multiple Surgery Procedures	03/22/2019	06/22/2019
Updates to Clinical Payment and Coding Policies	03/18/2019	06/18/2019

2018

Notice	Posted	Effective
Updates to Clinical Payment and Coding Policies	01/01/2019	04/01/2019
Update to Clinical Payment and Coding Policies – Facility & Professional Coding of Evaluation and Management of Emergency Department Services	12/01/2018	03/01/2019
Updates to Clinical Payment and Coding Policies	11/16/2018	02/15/2019
Updates to Clinical Payment and Coding Policies	10/26/2018	02/01/2019
02/01/2019 Update to the Blue Cross Medicare Advantage Preauthorization List	10/22/2018	02/01/2019
BCBSTX Preauthorization and Prenotification Changes Beginning January 1, 2019	10/03/2018	01/01/2019
New Preauthorization Requirements for Blue Choice PPO^SM H-E-B Members Only Effective Jan. 1, 2019	09/24/2018	01/01/2019
01/01/2019 Update to the Blue Cross Medicare Advantage Preauthorization List	09/17/2018	01/01/2019
Updates to Clinical Payment and Coding Policies Effective 11/1/2018	07/26/2018	11/1/2018
Updates to Clinical Payment and Coding Policies	07/02/2018	10/1/2018
New eviCore Email Notification for Utilization Management Decisions	06/14/2018	9/15/2018
Updates to Clinical Payment and Coding Policies	05/28/2018	9/1/2018
Updates to Clinical Payment and Coding Policies	03/29/2018	06/28/2018
Multiple Procedure Payment Reduction Effective July 1, 2018 For Certain Diagnostic Cardiovascular and Ophthalmology Procedures	03/29/2018	07/01/2018
New Preauthorization Requirements for Blue Choice PPO^SM HEB members	02/20/2018	02/20/2018

2017

Notice	Posted	Effective
CMS Jimmo Settlement	11/06/2017	11/06/2017
Two New "K" Codes for Therapeutic Continuous Glucose Monitors for Blue Cross Medicare Advantage PPO^SM and Blue Cross Medicare Advantage HMO^SM	10/27/2017	01/01/2018
Reimbursement Percentage Update for Modifier 52 (Reduced Services)	10/20/2017	02/01/2018
Fee Schedule Update	10/06/2017	10/01/2018
Blue Essentials Preauthorization Changes	10/02/2017	01/01/2018
Blue Advantage HMO & Blue Premier Preauthorization Changes	10/02/2017	01/01/2018
Blue Choice PPO Preauthorization Changes	10/02/2017	01/01/2018
Hospital/Facility Based Medical Group Provider Language Attachment	09/29/2017	01/01/2018
Psychological and Neuropsychological Testing	09/27/2017	10/01/2017
2018 Updates to the Blue Cross Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage (HMO)^SM Preauthorization Lists	09/18/2017	01/01/2018
Update to the Recoupment Policy for Blue Essentials^SM, Blue Advantage HMO^SM, Blue Premier^SM and HealthSelect^SM Network	08/17/2017	09/15/2017
Notice of changes to Billing and Documentation Information and Requirements	08/15/2017	09/15/2017
Code-Auditing Enhancement	08/14/2017	11/12/2017
Implant Payment and Coding	08/09/2017	11/15/2017
NICU Level of Care Authorization and Reimbursement - Clinical Payment and Coding Policy Posted	06/26/2017	10/01/2017
New ClaimsXten^TM Rules to be Implemented	06/12/2017	09/18/2017
BCBSTX New Employer Group Plan – Employees Retirement System of Texas (ERS) Effective Sept. 1, 2017	05/31/2017	09/01/2017
Announcing eviCore To Begin New Preauthorization Requirements for Blue Essentials^SM, and Blue Essentials Access^SM	05/26/2017	09/01/2017
Announcing eviCore To Begin New Preauthorization Requirements for Blue Choice PPO^SM, and Blue Premier^SM	05/01/2017	08/01/2017
Inpatient Unbundling – Clinical Payment and Coding Policy Posted	04/24/2017	07/24/2017
Evaluation and Management of Emergency Department Coding – Clinical Payment and Coding Policy Posted	04/24/2017	07/24/2017
ClaimsXten^TM Announces Software Version Upgrade	04/19/2017	07/17/2017
Rescheduled Implementation of Additional Code Auditing Software	03/16/2017	05/07/2017
Blue Cross Medicare Advantage HMO and Blue Cross Medicare Advantage PPO New Preauthorization Requirements through eviCore effective June 1, 2017	02/24/2017	06/01/2017
Medicare Outpatient Observation Notice for Blue Cross Medicare Advantage HMO^SM and Blue Cross Medicare Advantage PPO^SM	02/22/2017	03/01/2017
Additional Code-auditing Software Scheduled for May 7, 2017 Implementation	01/23/2017	02/07/2017

2016

Notice	Posted	Effective
Revised Effective Dates for Applied Behavioral Analysis Fee Schedule Update	12/27/2016	02/01/17 and 4/1/17
Important Changes Impacting Claims Submissions for BCBSTX Medicare Advantage Plans	12/07/2016	01/01/17
ClaimsXten^TM 1st Quarter 2017 Updates	12/05/2016	03/20/2017
Urinary Drug Test (UDT) Fee Schedule Update	10/25/16	02/01/17
Physician Payment Policies for Members enrolled in Blue Cross Medicare Advantage HMO^SM and Blue Cross Medicare Advantage PPO^SM	10/25/16	02/01/17
Applied Behavioral Analysis Fee Schedule Update	10/17/16	02/01/17
Update to After-Hours and Weekend Care Codes Payment Policy	10/12/16	01/01/17
Announcing Changes that Will Affect Claims Submissions for Medicare Advantage Plans	09/30/16	01/01/17
2017 Updates to the Blue Cross Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage (HMO)^SM Preauthorization Lists	09/29/16	01/01/17
Update to Blue Advantage HMO^SM and Blue Advantage Plus^SM HMO Preauthorization/Referral List – Preauthorization Required for Specific Outpatient Surgeries	09/28/16	01/01/17
Announcing a New Change for Rehabilitative and Habilitative Services for Members Enrolled in Qualified Health Plans under the Affordable Care Act	09/28/16	01/01/17
New Preauthorization Requirement for Applied Behavior Analysis for BCBSTX Members Enrolled in Blue Choice PPO^SM	09/28/16	01/01/17
Notification for Inpatient Admission for Post Stabilization Care Required Within One Business Day	09/27/16	01/01/17
New Preauthorization Requirements through eviCore	06/28/16	10/03/16
ClaimsXten^TM New Specialty Pharmacy Rule – Notification of Postponement	06/01/16	08/15/16
ClaimsXten^TM Outpatient Facility Rules: Notice of Postponement for BlueCard^® Host	05/24/16	07/18/16
ClaimsXten^TM 2nd Quarter 2016 Updates and New Specialty Pharmacy Rule Notification	04/18/16	07/18/16
Enroll in Medicare as a Provider with CMS	02/01/16	06/1/16

2015

Notice	Posted	Effective
ClaimsXten^TM 1st Quarter 2016 Updates and New Rule Notification	12/21/15	03/21/16
Claims with More Than One Unit Count for Drug Test Codes	10/29/15	02/01/16
New Effective Date: ClaimsXten^TM Adds Three New Outpatient Facility Rules	10/05/15	02/22/16
Updates to the Blue Cross Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage (HMO)^SM Preauthorization Lists	10/02/15	01/01/16
ClaimsXten^TM Edits for Compression Device Accessories, Effective Dec. 14, 2015	09/11/15	12/14/15
Claims with More Than One Unit Count for Drug Test Codes	09/04/15	01/01/16
Important Notice Regarding Category II Codes	09/04/15	12/15/15
Intranasal Application of Topical Anesthetic	07/31/15	11/01/15
Fee Schedule Update	07/27/15	11/01/15
Important Notice Regarding Billing for Point of Use Convenience Kits	07/17/15	11/01/15
ClaimsXten Adds Three New Outpatient Rules	07/13/15	10/12/15
Important Notice Regarding Billing for Point of Use Convenience Kits	07/01/15	10/01/15
Venipunctures for Hospital's and ASC's	05/29/15	09/01/15
Updates to the Blue Cross Medicare Advantage (PPO)^SM Preauthorization List	04/22/15	05/01/15
ClaimsXten^TM System Edit Updates, Effective June 2015	03/17/15	06/15/15
Diagnostic imaging management program change notice Blue Advantage HMO and Blue Cross Medicare Advantage PPO	02/24/15	04/01/15
Updates to the Blue Cross Medicare Advantage (PPO)^SM Preauthorization List	01/30/15	05/01/15
ClaimsXten^TM Updates – 1st Quarter 2015	01/14/14	04/20/15

2014

Notice	Posted	Effective
ClaimsXten^™ March 2015 Updates	12/23/14	03/23/15
ClaimsXten™ Fourth Quarter 2014 Updates	09/08/14	12/09/14
ClaimsXten^TM November 2014 Update	08/5/14	11/03/14
2014 DMERC Rates were updated to the Specialty DME Schedule effective 11/01/2014.	08/01//14	11/01/14
ClaimsXten^TM October 2014 Update	07/30/14	10/28/14
ClaimsXten^TM Third Quarter 2014 Updates	07/01//14	09/29/14
IVIG Drug Program	06/12/14	10/01/14
2009, 2010, 2011, 2012 and 2013 Hospital OP Based Compensation Schedule – Non Surgical Other Procedure Updates	05/15/14	08/15/14
Performance Measurement Codes	03/28/14	07/01/14
Fee Schedule Update	03/28/14	07/01/14
June 1, 2014 updates have been posted to the 2010 Home Health Therapy Base Compensation schedule site	03/01/14	06/01/14
ClaimsXten™ 2^nd Quarter 2014 Updates	02/18/14	05/19/14
ClaimsXten™ 1^st Quarter 2014 Updates	11/05/13	02/10/14
Multiple Surgery Pricing Per Session Methodology Update	10/28/13	02/01/14

2013

Notice	Posted	Effective
ClaimsXten^TM First Quarter 2014 Updates	11/5/13	02/10/14
Multiple Surgery Pricing Per Session Methodology Update	10/28/13	02/01/14
Billing with National Drug Codes (NDCs)	08/30/13	12/15/13
Fee Schedule Update	08/30/13	12/15/13
Multiple Imaging Procedures Reduction	07/26/13	11/01/13
ClaimsXten^TM Third Quarter 2013 Updates^TM Code Auditing Tool	07/15/13	10/14/13
Enhancements to ClaimsXten^TM Code Auditing Tool	04/12/13	07/15/13
Enhancements to ClaimsXten^TM Code Auditing Tool	02/04/13	05/05/13
IVIG Drug Program	01/04/13	02/01/13

2012

Notice	Posted	Effective
CPT Code 55250	02/19/13	11/01/12
Billing with National Drug Codes (NDCs)	10/04/12	Delayed until further notice
Modifier Reimbursement Changes	7/30/12	11/01/12
Fee Schedule Update	7/26/12	11/01/12
Billing with National Drug Codes (NDCs)	4/13/12	7/15/12
Code Auditing Update	2/7/12	5/7/12

2011

Notice	Posted	Effective
Professional Fee Schedule Update	6/1/11	9/1/11
Ancillary Fee Schedule Update	6/1/11	9/1/11
Fee Schedule Update (Professional)	5/27/11	9/1/11
Update to Code Auditing Tool Effective 5/2/2011	5/2/11	5/2/11
Fee Schedule Update — Immunizations	3/1/11	6/1/11
New Code Auditing Tool to Help Improve Claim Processing — ClaimsXten	12/14/10	4/18/11
Multiple Surgery Pricing Per Session Methodology — Update	10/27/10	1/31/11
Behavioral Health Program Changes Eff 01/2011	8/23/10	1/1/11

2010

Notice	Posted	Effective
2009 & 2010 Hospital OP Based Compensation Schedule — Non Surgical OTHER Updates	8/15/10	11/15/10
2009 ASC Base Compensation Schedule — Non Surgical OTHER Updates	8/15/10	11/15/10
2009 ASC Base Compensation Schedule — ASC Approved Procedures Updates	8/15/10	11/15/10
2009 ASC Base Compensation Schedule — APC Grouped Procedures Updates	8/15/10	11/15/10
2009 Hospital ASC Approved Procedures Updates	8/15/10	11/15/10
2009 Hospital ASC APC Group Procedures Updates	8/15/10	11/15/10
Code Auditing & Modifier 59 Exempt Auditing	3/16/10	7/26/10
Ancillary Fee Schedule Update	4/1/10	7/1/10
Professional Fee Schedule Update	4/1/10	7/1/10
Multiple Surgery Pricing Per Session Methodology	3/31/10	7/1/10
New Exclusive HMO and Preferred Statewide PPO/POS Clinical Reference Lab Provider Effective June 1, 2010	3/16/10	6/1/10
Change to HMO Blue Texas Outpatient Clinical Reference Lab Services Effective June 1, 2010	2/19/10	6/1/10

2009

Notice	Posted	Effective
Evidence Based Reimbursement	11/15/09	12/15/09
Change to HMO Blue^® Texas Outpatient Clinical Reference Lab Services Effective November 1, 2009	7/14/09	11/1/09
Fee Schedule Update	5/15/09	8/15/09
Are You Billing for Compound Drugs?	5/15/09	8/15/09

2008

Notice	Posted	Effective
CPT Code S9088 — Urgent Care Center Services	11/26/08	3/1/09
Change to the HMO Blue Texas Outpatient Clinical Reference Lab Services	8/22/08	12/1/08

2007

Notice	Posted	Effective
Six Counties Added to AIM's Preauthorization Program	7/30/07	11/1/07
Change to Services Requiring HMO Blue Texas Preauthorization	6/18/07	6/25/07
Milliman Care Guidelines^®	2/6/07	6/25/07