| Anesthesia Clinical Payment and Coding Information | Policy Number | Effective Date | End Date |
|---|---|---|---|
| Anesthesia Clinical Payment and Coding Information | CPCP010 | 12/22/2022 | 06/25/2023 |
| Anesthesia Clinical Payment and Coding Information | CPCP010 | 12/29/2021 | 12/21/2022 |
| Anesthesia Clinical Payment and Coding Information | CPCP010 | 07/20/2020 | 12/28/2021 |
| Anesthesia Clinical Payment and Coding Information | CPCP010 | 02/01/2019 | 07/19/2020 |
| Anesthesia Clinical Payment and Coding Information | CPCP010 | 10/01/2018 | 01/31/2019 |
| Applied Behavior Analysis | Policy Number | Effective Date | End Date |
| Applied Behavior Analysis | CPCP011 | 03/03/2021 | 02/28/2021 |
| Applied Behavior Analysis for Autism Spectrum Disorders | CPCP011 | 07/10/2020 | 03/02/2021 |
| Applied Behavior Analysis for Autism Spectrum Disorders | CPCP011 | 06/18/2019 | 07/09/2020 |
| Applied Behavior Analysis for Autism Spectrum Disorders | CPCP011 | 06/01/2018 | 06/17/2019 |
| Chiropractic Services | Policy Number | Effective Date | End Date |
| Chiropractic Services | CPCP016 | 01/14/2022 | 06/25/2023 |
| Chiropractic Services | CPCP016 | 10/15/2020 | 01/13/2022 |
| Chiropractic services | CPCP016 | 12/03/2019 | 10/14/2020 |
| Chiropractic Services | CPCP016 | 10/25/2019 | 12/02/2019 |
| Chiropractic Services | CPCP016 | 09/01/2018 | 10/24/2019 |
| Co-Surgeon/Team Surgeon Modifiers | Policy Number | Effective Date | End Date |
| Co-Surgeon/Team Surgeon Modifiers | CPCP009 | 11/01/2021 | 01/31/2023 |
| Co-Surgeon/Team Surgeon Modifiers | CPCP009 | 10/15/2020 | 10/31/2021 |
| Co-Surgeon/Team Surgeon Modifiers | CPCP009 | 09/03/2019 | 10/14/2020 |
| Co-Surgeon/Team Surgeon Modifiers | CPCP009 | 10/15/2018 | 09/02/2019 |
| Co-Surgeon/Team Surgeon Modifiers | CPCP009 | 06/28/2018 | 10/14/2018 |
| Coordinated Home Care/Private Duty Nursing | Policy Number | Effective Date | End Date |
| Coordinated Home Care /Private Duty Nursing Policy | CPCP005 | 12/01/2021 | 12/12/2022 |
| Coordinated Home Care /Private Duty Nursing Policy | CPCP005 | 10/15/2020 | 11/30/2021 |
| Coordinated Home Care /Private Duty Nursing Policy Guideline | CPCP005 | 01/01/2020 | 10/14/2020 |
| Coordinated Home Care Policy | CPCP005 | 02/15/2019 | 12/31/2019 |
| Corrected Claim Submissions | Policy Number | Effective Date | End Date |
| Corrected Claim Submissions | CPCP025 | 01/15/2020 | 08/14/2020 |
| Drug Testing Clinical Payment and Coding Policy | Policy Number | Effective Date | End Date |
| Drug Testing Clinical Payment and Coding Policy | CPCP020 | 09/01/2021 | 03/26/2023 |
| Drug Testing Clinical Payment and Coding Policy | CPCP020 | 12/28/2020 | 08/31/2021 |
| Drug Testing Clinical Payment and Coding Policy | CPCP020 | 05/01/2020 | 12/27/2020 |
| Drug Testing Clinical Payment and Coding Policy | CPCP020 | 04/01/2019 | 04/30/2020 |
| Emergency Department Evaluation and Management (E/M) Services Coding – Facility Services | Policy Number | Effective Date | End Date |
| Emergency Department Services Evaluation and Management (E/M) Services Coding – Facility Services | CPCP003 | 03/20/2022 | 02/21/2023 |
| Emergency Department Services Evaluation and Management (E/M) Services Coding – Facility Services | CPCP003 | 02/25/2021 | 03/19/2022 |
| Emergency Department Services Evaluation and Management (E/M) Services Coding – Facility Services | CPCP003 | 01/25/2020 | 02/24/2021 |
| Facility & Professional Coding of Evaluation and Management of Emergency Department Services | CPCP003 | 03/01/2019 | 01/24/2020 |
| Evaluation and Management of Emergency Department Coding | CPCP003 | 06/01/2018 | 02/28/2019 |
| Evaluation and Management of Emergency Department Coding | CPCP003 | 7/24/2017 | 05/31/2018 |
| Evaluation and Management (E/M) Coding – Professional Provider | Policy Number | Effective Date | End Date |
| Evaluation and Management (E/M) Coding – Professional Provider | CPCP024 | 01/01/2021 | 04/30/2022 |
| Evaluation and Management (E/M) Coding – Professional Provider (Updated 12/16/2020 to add AMA code change) | CPCP024 | 01/01/2021 | 01/01/2021 |
| Evaluation and Management (E/M) Coding – Professional Provider (Note:CPCP024 was originally part of CPCP003) | CPCP024 | 01/25/2020 | 12/31/2020 |
| Facility & Professional Coding of Evaluation and Management of Emergency Department Services | CPCP003 | 03/01/2019 | 01/24/2020 |
| Evaluation and Management of Emergency Department Coding | CPCP003 | 06/01/2018 | 02/28/2019 |
| Evaluation and Management of Emergency Department Coding | CPCP003 | 7/24/2017 | 05/31/2018 |
| Global Surgical Package | Policy Number | Effective Date | End Date |
| Global Surgical Package | CPCP014 | 05/26/2021 | 06/12/2022 |
| Global Surgical Package | CPCP014 | 08/15/2021 | 05/25/2021 |
| Global Surgical Package | CPCP014 | 06/18/2019 | 08/14/2020 |
| Global Surgical Package | CPCP014 | 06/28/2018 | 06/17/2019 |
| Hernia Repair | Policy Number | Effective Date | End Date |
| Hernia Repair | CPCP012 | 10/1/2021 | 08/03/2022 |
| Hernia Repair | CPCP012 | 09/15/2020 | 09/30/2021 |
| Hernia Repair | CPCP012 | 06/18/2019 | 09/14/2020 |
| Hernia Repair | CPCP012 | 06/28/2018 | 06/17/2019 |
| Home Infusion | Policy Number | Effective Date | End Date |
| Home Infusion | CPCP019 | 12/20/2021 | 01/04/2023 |
| Home Infusion | CPCP019 | 10/10/2020 | 12/19/2021 |
| Home Infusion | CPCP019 | 01/01/2020 | 10/09/2020 |
| Implant Payment and Coding Policy (Note: This policy has been retired as of 03/31/2023) | Policy Number | Effective Date | End Date |
| Implant Payment and Coding Policy | CPCP007 | 10/10/2020 | 03/31/2023 |
| Implant Payment and Coding Policy | CPCP007 | 08/01/2019 | 10/09/2020 |
| Implant Payment and Coding Policy | CPCP007 | 11/15/2018 | 07/31/2019 |
| Implant Payment and Coding Policy | CPCP007 | 10/01/2018 | 11/14/2018 |
| Implant Payment and Coding Policy | CPCP007 | 11/15/2017 | 09/30/2018 |
| Increased Procedural Services (Modifier 22) | Policy Number | Effective Date | End Date |
| Increased Procedural Services (Modifier 22) | CPCP013 | 08/12/2021 | 03/06/2022 |
| Increased Procedural Services (Modifier 22) | CPCP013 | 07/20/2020 | 08/11/2021 |
| Increased Procedural Services (Modifier 22) | CPCP013 | 02/20/2019 | 07/19/2020 |
| Increased Procedural Services (Modifier 22) | CPCP013 | 06/27/2018 | 02/19/2019 |
| Inpatient Readmissions | Policy Number | Effective Date | End Date |
| Inpatient Readmissions | CPCP027 | 01/01/2022 | 06/30/2023 |
| Inpatient Readmissions | CPCP027 | 06/20/2020 | 12/31/2021 |
| Inpatient/Outpatient Unbundling Policy | Policy Number | Effective Date | End Date |
| Inpatient/Outpatient Unbundling Policy | CPCP002 | 03/18/2021 | 01/13/2022 |
| Inpatient/Outpatient Unbundling Policy | CPCP002 | 10/15/2019 | 03/17/2021 |
| Inpatient/Outpatient Unbundling Policy | CPCP002 | 08/01/2019 | 10/14/2019 |
| Inpatient/Outpatient Unbundling Policy | CPCP002 | 11/15/2018 | 07/31/2019 |
| Inpatient/Outpatient Unbundling Policy | CPCP002 | 10/01/2018 | 11/14/2018 |
| Inpatient Unbundling Policy | CPCP002 | 07/24/2017 | 09/30/2018 |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy | Policy Number | Effective Date | End Date |
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline |
CPCP032 | 11/10/2021 | 05/02/2022 |
| Laboratory Panel Billing | Policy Number | Effective Date | End Date |
| Laboratory Panel Billing | CPCP021 | 11/10/2021 | 04/13/2022 |
| Laboratory Panel Billing | CPCP021 | 06/10/2021 | 11/09/2021 |
| Laboratory Panel Billing Guideline | CPCP021 | 09/01/2020 | 06/09/2021 |
| Laboratory Panel Billing Guideline | CPCP021 | 07/18/2019 | 08/31/2020 |
| Medical Record Documentation Guideline | Policy Number | Effective Date | End Date |
| Medical Record Documentation Guideline | CPCP092 |
12/01/2021 | 12/25/2022 |
| Medical Record Documentation Guideline | CPCP029 | 07/12/2021 | 11/30/2021 |
| Medical Record Documentation Guideline | CPCP029 | 03/10/2020 | 07/11/2021 |
| Medical Record Documentation Guideline | CPCPG01 | 11/01/2019 | 03/09/2020 |
| Medical Record Documentation Guideline | CPCPG01 | 04/01/2019 | 10/31/2019 |
| Modifier Reference Policy | Policy Number | Effective Date | End Date |
| Modifier Reference Guideline | CPCP023 | 07/15/2022 | 06/25/2023 |
| Modifier Reference Guideline | CPCP023 | 07/15/2021 | 07/15/2022 |
| Modifier Reference Guideline | CPCP023 | 07/15/2021 | 07/15/2021 |
| Modifier Reference Guideline | CPCP023 | 07/10/2020 | 07/14/2021 |
| Modifier Reference Guideline | CPCP023 | 04/01/2019 | 07/09/2020 |
| Multiple Surgical Procedures | Policy Number | Effective Date | End Date |
| Multiple Surgical Procedures | CPCP015 | 12/01/2021 | 06/30/2022 |
| Multiple Surgical Procedures | CPCP015 | 11/10/2020 | 11/30/2021 |
| Multiple Surgical Procedures | CPCP015 | 06/22/2019 | 11/09/2020 |
| Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy | Policy Number | Effective Date | End Date |
| Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy (Note: on 2/15/2021, the 90-day effective date was corrected from 5/5/2021 to 4/5/2021) | CPCP004 | 04/05/2021 | 01/13/2022 |
| Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy | CPCP004 | 06/15/2020 | 04/04/2021 |
| Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy | CPCP004 | 07/15/2019 | 06/14/2020 |
| Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy | CPCP004 | 06/01/2018 | 07/14/2019 |
| Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy | CPCP004 | 10/01/2017 | 05/31/2018 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | Policy Number | Effective Date | End Date |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) NOTE: This policy applies ONLY to BCBSTX ERISA Administrative Services only (ASO) plans | CPCP028 | 01/01/2023 | 03/31/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) NOTE: This policy applies ONLY to BCBSTX ERISA Administrative Services only (ASO) plans | CPCP028 | 08/01/2022 | 12/31/2022 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) NOTE: Effective May 1, 2022, this policy applies ONLY to BCBSTX ERISA ASO plans. | CPCP028 | 04/15/2022 | 07/31/2022 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) Code removed eff 01/31/2022 | CPCP028 | 08/15/2021 | 04/14/2022 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) Code removed eff 01/31/2022 | CPCP028 | 08/15/2021 | 01/31/2022 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) Version updated with new AMA codes | CPCP028 | 08/15/2021 | 08/15/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 07/01/2021 | 08/14/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 05/15/2021 | 06/30/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 04/01/2021 | 05/14/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) Revised 12/14/2020 to include 01/01/2021 AMA code changes | CPCP028 | 03/01/2021 | 03/31/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) (Replaced before effective with above version due to AMA changes) | CPCP028 | 03/01/2021 | 03/01/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 01/01/2021 | 02/28/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 12/01/2020 | 12/31/2020 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) (Refer to Revision to Non-Reimbursable Experimental, Investigational and/or Unproven Services Policy) | CPCP028 | 12/01/2020 | 12/01/2020 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 09/01/2020 | 11/30/2020 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) Refer to Correction - Clinical Payment and Coding Policy Update | CPCP028 | 09/01/2020 | 09/01/2020 |
| Observation Services Tool For Applying MCG Care Guidelines | Policy Number | Effective Date | End Date |
| Observation Services Tool for Applying MCG Care Guidelines | CPCP001 | 06/15/2020 | 11/03/2021 |
| Observation Services Tool for Applying MCG Care Guidelines | CPCP001 | 08/01/2019 | 06/14/2020 |
| Observation Services Tool for Applying MCG Care Guidelines | CPCP001 | 09/01/2018 | 07/31/2019 |
| Observation Services Tool for Applying MCG Care Guidelines | CPCP001 | 11/01/2016 | 08/31/2018 |
| Paravertebral Facet Injection Procedure Coding & Billing Policy | Policy Number | Effective Date | End Date |
| Paravertebral Facet Injection Procedure Coding & Billing Policy | CPCP036 | 05/24/2022 | 01/05/2023 |
| Pneumatic Compression Devices – Outpatient Use | Policy Number | Effective Date | End Date |
| Pneumatic Compression Devices – Outpatient Use | CPCP022 | 04/12/2022 | 05/16/2023 |
| Pneumatic Compression Devices – Outpatient Use | CPCP022 | 10/01/2020 | 04/11/2022 |
| Pneumatic Compression Devices – Outpatient Use | CPCP022 | 11/01/2019 | 09/30/2020 |
| Point-of-Care Ultrasound Examination Policy | Policy Number | Effective Date | End Date |
| Point-of-Care Ultrasound Examination Policy | CPCP030 | 06/10/2021 | 03/06/2022 |
| Point-of-Care Ultrasound Examination Guideline | CPCP030 | 09/15/2020 | 06/09/2021 |
| Preventive Services Policy | Policy Number | Effective Date | End Date |
| Preventive Services Policy | CPCP006 | 03/01/2023 | 03/31/2023 |
| Preventive Services Policy | CPCP006 | 01/01/2023 | 02/28/2023 |
| Preventive Services Policy | CPCP006 | 10/01/2022 | 12/23/2022 |
| Preventive Services Policy | CPCP006 | 09/01/2022 | 08/31/2022 |
| Preventive Services Policy | CPCP006 | 07/01/2022 | 06/24/2022 |
| Preventive Services Policy | CPCP006 | 04/01/2022 | 06/30/2022 |
| Preventive Services Policy | CPCP006 | 01/01/2022 | 03/31/2022 |
| Preventive Services Policy | CPCP006 | 10/01/2021 | 12/31/2021 |
| Preventive Services Policy | CPCP006 | 07/01/2021 | 09/30/2021 |
| Preventive Services Policy | CPCP006 | 04/01/2021 | 06/30/2021 |
| Preventive Services Policy | CPCP006 | 01/15/2021 | 03/31/2021 |
| Preventive Services Policy | CPCP006 | 01/01/2020 | 01/14/2021 |
| Preventive Services Policy | CPCP006 | 10/01/2020 | 12/31/2020 |
| Preventive Services Policy | CPCP006 | 07/01/2020 | 09/30/2020 |
| Preventive Services Policy | CPCP006 | 01/01/2020 | 03/31/2020 |
| Preventive Services Policy | CPCP006 | 10/15/2019 | 12/31/2019 |
| Preventive Services Policy | CPCP006 | 10/01/2019 | 10/14/2019 |
| Preventive Services Policy | CPCP006 | 01/01/2019 | 09/30/2019 |
| Preventive Services Policy | CPCP006 | 11/01/2018 | 12/31/2018 |
| Preventive Services Policy | CPCP006 | 06/28/2018 | 10/31/2018 |
| Preventive Services Policy | CPCP006 | 07/07/2017 | 06/27/2018 |
| Psychological and Neuropsychological Testing | Policy Number | Effective Date | End Date |
| Psychological and Neuropsychological Testing | CPCP008 | 07/12/2021 | 02/07/2023 |
| Psychological and Neuropsychological Testing | CPCP008 | 07/10/2020 | 07/11/2021 |
| Psychological and Neuropsychological Testing | CPCP008 | 02/15/2019 | 07/09/2020 |
| Psychological and Neuropsychological Testing | CPCP008 | 08/01/2018 | 02/14/2019 |
| Psychological and Neuropsychological Testing | CPCP008 | 01/01/2018 | 07/31/2018 |
| Revenue Codes Requiring CPT or HCPCS Codes | Policy Number | Effective Date | End Date |
| Revenue Codes Requiring CPT® or HCPCS Codes | CPCP018 | 03/22/2022 | 01/31/2023 |
| Revenue Codes Requiring CPT® or HCPCS Codes | CPCP018 | 02/10/2021 | 03/21/2022 |
| Revenue Codes Requiring CPT® or HCPCS Codes | CPCP018 | 07/01/2020 | 02/09/2021 |
| Revenue Codes Requiring CPT or HCPCS Codes | CPCP018 | 10/25/2019 | 06/30/2020 |
| Revenue Codes Requiring CPT or HCPCS Codes | CPCP018 | 11/01/2018 | 10/24/2019 |
| Surgical and Non-Surgical Services | Policy Number | Effective Date | End Date |
| Surgical and Non-Surgical Services | TXCPCP003 | 03/10/2022 | 03/08/2023 |
| Surgical and Non-Surgical Services | TXCPCP03 | 07/12/2021 | 03/09/2022 |
| Telemedicine and Telehealth Services | Policy Number | Effective Date | End Date |
| Telemedicine and Telehealth Services | CPCP033 | 03/25/2021 | 03/27/2022 |
| Telemedicine and Telehealth Services Effective 02/12/2021 – added coverage for IOP Services |
CPCP033 | 02/12/2021 | 03/24/2021 |
| Telemedicine and Telehealth Services *adding CMS footnote | CPCP033 | 02/12/2021 | 02/12/2021 |
| Telemedicine and Telehealth Services | CPCP033 | 02/12/2021 | 02/12/2021 |
| Telemedicine and Telehealth Services | TXCPCP01 | 01/01/2021 | 02/11/2021 |
| Telemedicine and Telehealth Services | TXCPCP01 | 05/10/2020 | 12/31/2020 |
| Telemedicine and Telehealth Services | TXCPCP01 | 07/01/2019 | 05/09/2020 |
| Telemedicine and Telehealth Services | TXCPCP01 | 11/01/2018 | 06/30/2019 |
| Telemedicine and Telehealth Services | TXCPCP01 | 04/04/2018 | 10/31/2018 |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding | Policy Number | Effective Date | End Date |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding | CPCP026 | 12/20/2021 | 04/04/2023 |
| Trauma Activation | Policy Number | Effective Date | End Date |
| Trauma Activation | CPCP031 | 08/26/2021 | 03/06/2022 |
| Trauma Activation | CPCP031 | 09/01/2020 | 08/25/2021 |
| Trauma Activation | TXCPCP02 | 07/01/2019 | 08/31/2020 |
| Unbundled Policy - Professional Providers | Policy Number | Effective Date | End Date |
| Unbundled Policy - Professional Providers | CPCP034 | 11/12/2021 | 04/10/2022 |
| Unlisted/Not Otherwise Classified (NOC) Coding Policy | Policy Number | Effective Date | End Date |
| Unlisted/Not Otherwise Classified (NOC) Coding Policy | CPCP035 | 01/08/2022 | 09/19/2022 |
| Wasted/Discarded Drugs and Biologicals Guideline | Policy Number | Effective Date | End Date |
| Wasted/Discarded Drugs and Biologicals Guideline | CPCP017 | 01/14/2022 | 05/15/2023 |
| Wasted/Discarded Drugs and Biologicals Guideline | CPCP017 | 11/08/2021 | 01/13/2022 |
| Wasted/Discarded Drugs and Biologicals Guideline | CPCP017 | 01/10/2021 | 11/07/2021 |
| Wasted/Discarded Drugs and Biologicals Guideline | CPCP017 | 10/25/2019 | 01/09/2021 |
| Wasted/Discarded Drugs and Biologicals Guideline | CPCP017 | 10/12/2018 | 10/24/2019 |