| Reimbursement Changes and Updates |
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| BCBSTX Relative Values |
Assistant Surgery allowable is 16 % of the Surgery rate. Physician Assistants, Advance Nurse Practitioners, Registered Nurse First Assistants, Licensed Surgical Assistants, Clinical Nurse Specialists and Nurse Midwives will be reimbursed 85% of the rates posted on the internet except for Drugs, Clinical Lab, Other Lab, Durable Medical Equipment/Prosthetics and Orthotics. Drugs, Clinical Lab, Other Lab, Durable Medical Equipment/ Prosthetics and Orthotics will be reimbursed at 100% of the rates posted on the internet. |
Facility Relative Values
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| Lab |
Professional component for procedures listed on the Lab Schedules will be reimbursed at $5 for HMO and $5.50 for PPO. Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount. |
Clinical Lab Schedule
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| Durable Medical Equipment/Prosthetics and Orthotics |
Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount |
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| Drugs |
Note: The Drug/Injectable Fee Schedule will be updated on the following dates: 9/1/2012, 12/1/2012, 3/1/2013, and 6/1/2013. Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount.
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| Other Codes |
Assistant Surgery allowable is 16% of the Surgery rate. Physician Assistants, Advance Nurse Practitioners, Registered Nurse First Assistants, Licensed Surgical Assistants, Clinical Nurse Specialists and Nurse Midwives will be reimbursed 85% of the rates posted on the internet except for Drugs, Clinical Lab, Other Lab, Durable Medical Equipment/Prosthetics and Orthotics. Drugs, Clinical Lab, Other Lab, Durable Medical Equipment/ Prosthetics and Orthotics will be reimbursed at 100% of the rates posted on the internet. Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount. |
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