Revised Clinical Payment and Coding Policies

May 1, 2019

Blue Cross and Blue Shield of Texas has implemented clinical payment and coding policies based on criteria developed by specialized professional societies, national guidelines (e.g. MCG^TM) and the Centers for Medicare & Medicaid Services (CMS) Provider Reimbursement Manual. Additional sources are used and can be provided upon request. 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.

Effective Aug. 1, 2019, the following policies are being updated:

• Implant Payment and Coding Policy
• Inpatient/Outpatient Unbundling Policy
• Observation Services Tool for Applying MCG Care Guidelines

Refer to Clinical Payment and Coding Policies under Standards and Requirements on the provider website to review the current CPCPs.

If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.