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
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 03/01/2022 08/31/2023
Applied Behavior Analysis CPCP011 03/03/2021 02/28/2022
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
06/26/2023 01/25/2024
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 02/01/2023 01/18/2024
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 08/15/2020 06/30/2024
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  03/27/2023 03/06/2024
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 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) 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
04/20/2023 12/07/2023
Evaluation and Management (E/M) Coding – Professional Provider CPCP024 05/01/2022 04/19/2023
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 -Professional Providers Policy Number Effective Date End Date
Global Surgical Package - Professional Providers
CPCP014
10/01/2023 01/19/2024
Global Surgical Package - Professional Providers CPCP014 06/13/2022 08/31/2023
Global Surgical Package - Professional Providers CPCP014 05/26/2021 06/12/2022
Global Surgical Package - Professional Providers CPCP014 08/15/2020 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 08/04/2022 08/17/2023
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
08/15/2023 01/18/2024
Increased Procedural Services (Modifier 22) CPCP013 03/07/2022 08/14/2023
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 07/01/2023 10/23/2023
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-Facility
CPCP002
01/14/2022 03/05/2024
Inpatient/Outpatient Unbundling Policy-Facility 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 04/14/2022 09/27/2023
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 06/26/2023 04/18/2023
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
07/01/2022 01/23/2024
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 CPCP004  01/14/2022 03/05/2024
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)  - 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 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
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) CPCP028 08/01/2022 12/31/2022
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)   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 11/04/2021 08/31/2023
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
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 Coding & Billing Policy Policy Number Effective Date
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
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 03/07/2022 03/05/2024
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
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
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
02/08/2023
12/06/2023
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 TXCPCP03 03/10/2022 03/08/2023
Surgical and Non-Surgical Services TXCPCP03 07/12/2021 03/09/2022
Telemedicine and Telehealth/Virtual Health Care Services Policy  Policy Number Effective Date End Date
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
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 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 03/07/2022 10/17/2023
Trauma Activation - Facility Services  CPCP031 08/26/2021 03/06/2022
Trauma Activation - Facility Services  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 04/11/2022 08/14/2023
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 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
Wasted/Discarded Drugs and Biologicals Policy 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

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