Fee Schedule Update for BCBSTX DME, Prosthetic and Orthotics Providers

Effective March 1, 2023, Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the maximum allowable fee schedule for Blue Choice PPOSM, Blue EssentialsSM (including the Health Select Network), Blue PremierSM, Blue High Performance, Blue Advantage HMOSM, MyBlue Health and ParPlan networks (collectively referred to as “Networks”) for in-network BCBSTX Durable Medical Equipment (DME), Prosthetic and Orthotic providers.

All files and fee schedules for the Networks will be posted on on the provider website under Standards & Requirements then select General Reimbursement Information. Locate  the Reimbursement Schedules and Related Information section. Please contact the Ancillary Network Management Department for the Secure Content password to access the Network fee schedules.The following is a brief description of the changes:

The methodology used to develop the maximum allowable fee schedules will be based on 2022 CMS values as posted on the website for those services for which the BCBSTX reimbursement is based on CMS values. 

BCBSTX provides general reimbursement information policies, fee schedule request forms and fee schedule information on the provider website. Reimbursement changes and updates will be posted under "Reimbursement Changes/Updates" in the Reimbursement Schedules section on the website. The specific effective date will be noted for each change that is posted.

Please be advised the reimbursement information being disclosed within this letter and the attachment contains confidential information proprietary to BCBSTX. The use and disclosure of this information is restricted under Texas Insurance Code Section 1301.136(b), Texas Insurance Code Section 843.321(b) and the terms of your Network agreement(s), as applicable. 

We value your participation as a contracted provider. As some Networks are limited in scope or geographic area, if you are not participating in one of the Networks, please disregard the information pertaining to that particular network. If you have questions, please contact the Ancillary Network Management Department.