We have revised the Clinical Payment and Coding Policy (CPCP) for Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) effective August 1, 2022 and posted it to the Blue Cross and Blue Shield of Texas (BCBSTX) provider website.
Also note, this new policy and the current policy effective 04/15/2022, only apply to BCBSTX ERISA Administrative Services Only (ASO) plans as of May 1, 2022. Refer to Clinical Payment and Coding Policies under Standards and Requirements on the provider website to review the current CPCPs.
Be sure to check eligibility and benefits before rendering service(s) to make sure a procedure is a covered benefit for the member. You can determine if the member is in an ERISA ASO plan by contacting the customer service phone number on the back of the member’s ID card.
Clinical payment and coding policies are based on using healthcare professionals and industry standard guidelines. The clinical payment and coding guidelines are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.