Clinical Payment and Coding Policy — Archived Documents

 

Anesthesia Clinical Payment and Coding Information Policy Number Effective Date End Date
Anesthesia Information
CPCP010
06/26/2023 05/31/2024
Anesthesia Information CPCP010 12/22/2022 06/25/2023
Applied Behavior Analysis Policy Number Effective Date End Date
Applied Behavior Analysis
CPCP011 09/01/2023 01/31/2025
Applied Behavior Analysis CPCP011 03/01/2022 08/31/2023
Chiropractic Services Policy Number Effective Date End Date
Chiropractic Services CPCP016
06/26/2023 01/25/2024
Chiropractic Services CPCP016 01/14/2022 06/25/2023
Co-Surgeon/Team Surgeon Modifiers Policy Number Effective Date End Date
Co-Surgeon/Team Surgeon Modifiers CPCP009 01/19/2024 04/17/2025
Co-Surgeon/Team Surgeon Modifiers CPCP009 02/01/2023 01/18/2024
Co-Surgeon/Team Surgeon Modifiers CPCP009 11/01/2021 01/31/2023
Corrected Claim Submissions Policy Number Effective Date End Date
Corrected Claim Submissions CPCP025 07/01/2024 01/07/2025
Corrected Claim Submissions CPCP025 08/15/2020 06/30/2024
Drug Testing Clinical Payment and Coding Policy Policy Number Effective Date End Date
Drug Testing Clinical Payment and Coding Policy CPCP020 03/07/2024 02/12/2025
Drug Testing Clinical Payment and Coding Policy CPCP020  03/27/2023 03/06/2024
Drug Testing Clinical Payment and Coding Policy CPCP020 09/01/2021 03/26/2023
Emergency Department Services Evaluation and Management: E/M Coding – Facility Services Policy Number Effective Date End Date
Emergency Department Evaluation and Management (E/M) Services Coding - Facility Services CPCP003 10/25/2023 05/25/2024
Emergency Department Evaluation and Management (E/M) Services Coding - Facility Services CPCP003 02/22/2023 10/24/2023
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 Coding – Professional Services Policy Number Effective Date End Date
Emergency Department Evaluation and Management (E/M) Services Coding — Professional Services CPCP042 10/25/2023 10/04/2024
Evaluation and Management (E/M) Coding – Professional Provider  Policy Number Effective Date End Date
Evaluation and Management (E/M) Coding – Professional Provider CPCP024 12/08/2023 11/17/2024
Evaluation and Management (E/M) Coding – Professional Provider CPCP024
04/20/2023 12/07/2023
Evaluation and Management (E/M) Coding – Professional Provider CPCP024 05/01/2022 04/19/2023
Global Surgical Package -Professional Providers Policy Number Effective Date End Date
Global Surgical Package - Professional Providers CPCP014 01/22/2024 04/14/2025
Global Surgical Package - Professional Providers
CPCP014
10/01/2023 01/21/2024
Global Surgical Package - Professional Providers CPCP014 06/13/2022 08/31/2023
Hernia Repair Policy Number Effective Date End Date
Hernia Repair CPCP012 08/18/2023 10/09/2024
Hernia Repair CPCP012 08/04/2022 08/17/2023
Home Health Care/Private Duty Nursing Policy
Policy Number
Effective Date
End Date
Home Health Care/Private Duty Nursing Policy CPCP005 04/24/2024 03/20/2025
Home Health Care/Private Duty Nursing Policy CPCP005 12/13/2022 04/23/2024
Home Infusion Policy Number Effective Date End Date
Home Infusion CPCP019 01/05/2023 04/21/2024
Home Infusion CPCP019 12/20/2021 01/04/2023
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
Increased Procedural Services (Modifier 22) Policy Number Effective Date End Date
Increased Procedural Services (Modifier 22) CPCP013 01/19/2024 04/14/2025
Increased Procedural Services (Modifier 22) CPCP013 08/15/2023 01/18/2024
Increased Procedural Services (Modifier 22) CPCP013 03/07/2022 08/14/2023
Inpatient Readmissions Policy Number Effective Date End Date
Inpatient Readmissions CPCP027 10/24/2023 12/17/2024
Inpatient Readmissions CPCP027 07/01/2023 10/23/2023
Inpatient Readmissions CPCP027 01/01/2022 06/30/2023
Inpatient/Outpatient Unbundling Policy - Facility Policy Number Effective Date End Date
Inpatient/Outpatient Unbundling Policy - Facility CPCP002
01/14/2022 03/05/2024
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy Policy Number Effective Date End Date
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy CPCP032 04/30/2024 10/03/2024
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy CPCP032 05/03/2022 04/29/2024
Laboratory Panel Billing Policy Number Effective Date End Date
Laboratory Panel Billing CPCP021
09/28/2023 07/10/2024
Laboratory Panel Billing CPCP021 04/14/2022 09/27/2023
Medical Record Documentation Policy Number Effective Date End Date
Medical Record Documentation CPCP029 07/24/2024 11/13/2024
Medical Record Documentation CPCP029 12/26/2022 07/23/2024
Modifier Reference Policy Policy Number Effective Date End Date
Modifier Reference Policy CPCP023 06/26/2023 04/18/2023
Modifier Reference Policy CPCP023 07/15/2022 06/25/2023
Multiple Surgical Procedures Policy Number Effective Date End Date
Multiple Surgical Procedures CPCP015 01/24/2024 04/22/2025
Multiple Surgical Procedures
CPCP015
07/01/2022 01/23/2024
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 CPCP004 03/06/2024 07/30/2024
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy CPCP004  01/14/2022 03/05/2024
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)  - NOTE: Effective 05/01/2022, this policy applies ONLY to BCBSTX ERISA Administrative Services only (ASO) plans Policy Number Effective Date End Date
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) CPCP028 10/01/2024 05/14/2025
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) - Updated 06/27/2024 CPCP028 07/01/2024 09/30/2024
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) NOTE: This version was retired prior to the effective date. Never active. CPCP028 07/01/2024 07/01/2024
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) CPCP028 05/15/2024 06/30/2024
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) - NOTE: This version was retired prior to the effective date. Never active. CPCP028 05/15/2024 05/15/2024
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) CPCP028 04/01/2024 05/14/2024
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)
CPCP028
01/15/2024 03/31/2024
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) CPCP028 12/01/2023 01/14/2024
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) CPCP028 10/01/2023 11/30/2023
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) CPCP028 09/01/2023 09/30/2023
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) CPCP028 07/01/2023 08/31/2023
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) - Updated 05/31/2023 CPCP028 04/01/2023 06/30/2023
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) CPCP028 04/01/2023 05/31/2023
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) CPCP028 01/01/2023 03/31/2023
Observation Services Policy Policy Number Effective Date End Date
Observation Services Policy  CPCP001 09/01/2023 08/13/2024
Observation Services Policy CPCP001 11/04/2021 08/31/2023

Outpatient Facility Service(s) Overlapping During an Inpatient Stay
Policy Number Effective Date End Date
Outpatient Facility Service(s) Overlapping During an Inpatient Stay CPCP039 09/01/2023 07/12/2024
Outpatient Services Prior to an Inpatient Admission Policy Number
Effective Date
End Date
Outpatient Services Prior to an Inpatient Admission CPCP038 08/01/2023
02/21/2024
Paravertebral Facet Injection Procedure Billing & Coding Policy Policy Number Effective Date End Date
Paravertebral Facet Injection Procedure Billing & Coding Policy CPCP036 04/25/2024 02/12/2025
Paravertebral Facet Injection Procedure Coding & Billing Policy CPCP036 01/06/2023 04/24/2024
Paravertebral Facet Injection Procedure Coding & Billing Policy CPCP036 01/05/2023 01/06/2023
Paravertebral Facet Injection Procedure Coding & Billing Policy CPCP036 05/24/2022 01/05/2023
Physical Medicine and Rehabilitation Services Policy Number  Effective Date End Date
Physical Medicine and Rehabilitation Services CPCP040 06/26/2023 01/21/2024
Pneumatic Compression Devices – Outpatient Use Policy Number Effective Date End Date
Pneumatic Compression Devices – Outpatient Use CPCP022
05/17/2023 02/23/2024
Pneumatic Compression Devices – Outpatient Use CPCP022 04/12/2022 05/16/2023
Point-of-Care Ultrasound Examination Policy Policy Number Effective Date End Date
Point-of-Care Ultrasound Examination Policy CPCP030 03/06/2024 01/06/2025
Point-of-Care Ultrasound Examination Policy CPCP030 03/07/2022 03/05/2024
Preventive Services Policy Policy Number Effective Date End Date
Preventive Services Policy CPCP006 02/01/2025 03/31/2025
Preventive Services Policy CPCP006 01/01/2025 01/31/2025
Preventive Services Policy CPCP006 10/01/2024 12/31/2024
Preventive Services Policy CPCP006 07/01/2024 09/30/2024
Preventive Services Policy CPCP006
04/01/2024 06/30/2024
Preventive Services Policy CPCP006 01/01/2024 03/31/2024
Preventive Services Policy CPCP006 11/01/2023 12/31/2023
Preventive Services Policy CPCP006
10/01/2023 10/31/2023
Preventive Services Policy CPCP006 07/01/2023 09/30/2023
Preventive Services Policy CPCP006 04/01/2023 06/30/2023
Preventive Services Policy CPCP006 03/01/2023 03/31/2023
Preventive Services Policy CPCP006 01/01/2023 02/28/2023
Psychological and Neuropsychological Testing Policy Number Effective Date End Date
Psychological and Neuropsychological Testing CPCP008 12/07/2023 02/12/2025
Psychological and Neuropsychological Testing CPCP008
02/08/2023
12/06/2023
Psychological and Neuropsychological Testing CPCP008 07/12/2021 02/07/2023
Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes - Outpatient Facility Claims (formerly Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT®, HCPCS and/or NDC Codes) Policy Number  Effective Date End Date
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes  CPCP018 04/23/2024 04/13/2025
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes  CPCP018 04/19/2024 04/22/2024
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT®, HCPCS and/or NDC Codes
CPCP018 02/01/2023 04/21/2024
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT®, HCPCS and/or NDC Codes
CPCP018 03/22/2022 01/31/2023
Sepsis Policy  Policy Number Effective Date End Date
Sepsis Policy CPCP041 07/16/2024 03/31/2025
Sepsis Policy CPCP041 09/06/2023 07/15/2024
Surgical and Non-Surgical Services Policy Number Effective Date End Date
Surgical and Non-Surgical Services TXCPCP03 03/09/2023 09/05/2024
Surgical and Non-Surgical Services TXCPCP03 03/10/2022 03/08/2023
Telemedicine and Telehealth/Virtual Health Care Services Policy  Policy Number Effective Date End Date
Telemedicine and Telehealth/Virtual Health Care Services Policy CPCP033 05/01/2024 12/31/2024
Telemedicine and Telehealth/Virtual Health Care Services Policy  CPCP033 03/08/2024 04/30/2024
Telemedicine and Telehealth/Virtual Health Care Services Policy CPCP033 03/28/2022 03/07/2024
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding Policy Number Effective Date End Date
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding CPCP026 05/17/2023 11/20/2024
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding CPCP026 04/05/2023 05/16/2023
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding CPCP026 12/20/2021 04/04/2023
Trauma Activation - Facility Services  Policy Number Effective Date End Date
Trauma Activation - Facility Services CPCP031 10/18/2023 07/31/2024
Trauma Activation - Facility Services CPCP031 03/07/2022 10/17/2023
Unbundled Policy - Professional Providers Policy Number Effective Date End Date
Unbundled Policy - Professional Providers CPCP034
08/15/2023 06/24/2024
Unbundled Policy - Professional Providers CPCP034 04/11/2022 08/14/2023
Unlisted/Not Otherwise Classified (NOC) Coding Policy  Policy Number Effective Date End Date
Unlisted/Not Otherwise Classified (NOC) Coding Policy
CPCP035 09/20/2022 08/28/2024
Wasted/Discarded Drugs and Biologicals Policy Policy Number Effective Date End Date
Wasted/Discarded Drugs and Biologicals Policy CPCP017 05/16/2023 03/04/2024
Wasted/Discarded Drugs and Biologicals Policy CPCP017 01/14/2022 05/15/2023

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