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

The ParPlan, BlueChoice® and HMO Blue® Texas (Independent Provider Network and THE Limited Provider Network only) maximum allowable fees for practitioners will be updated to reflect 2011 relative values effective September 1, 2011.

  • 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, 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.

  • Note: In May 2011, BCBSTX announced that the Procedure Plus an Evaluation and Management Service Reimbursement Methodology would be implemented effective September 1, 2011. BCBSTX has decided NOT to implement the Procedure Plus an Evaluation and Management Service Reimbursement Methodology as indicated in the following paragraph: If a claim (or claims) from the same physician, for the same date of service, for the same member includes both a procedure and a general ophthalmological service or an evaluation and management service, the general ophthalmological service or evaluation and management service will be considered as the primary service and payable at 100% of the allowable amount and the procedure will be considered the secondary service payable at 95% of the allowable amount. The procedure list can be found on the Blue Cross and Blue Shield of Texas (BCBSTX) Provider website Home Page, under the Standards & Requirements tab, click on "View General Reimbursement Information", then scroll down to the "All Product News" section, then click on "Procedure Plus an Evaluation and Management Service."

  • Note: For the most current information on Billing with National Drug Codes (NDCs), go to the Billing with National Drug Codes article posted 2/01/2012 located in the News & Updates (View All) area of this website.

  • 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 local Professional Provider Network office.