09/30/2022 - Updated 12/29/2022
We have added some additional revisions to the Clinical Payment and Coding Policy (CPCP) for CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) effective Jan. 1, 2023 and posted it to the Blue Cross and Blue Shield of Texas (BCBSTX) provider website. The additional changes include CPT® codes added that are effective 01/01/2023 and not available when the previous policy posted 9/30/2022.
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.
If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.
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.