Professional Fee Schedule Request

Please Note:

  • This Fee Schedule Request Form is applicable to Blue Cross and Blue Shield of Texas (BCBSTX) Participating Physicians and Professional Providers Only.
  • Dental (DDS) providers, contracted with the Dental Network of America (DNOA, must email DNOA for reimbursement related questions or fee schedule requests.
  • Non-contracting provider reimbursement, contact Provider Customer Service at 1-800-451-0287 for reimbursement information.

How to Request

Access the BCBSTX participating physician and professional provider Fee Schedule Request Form by selecting the county where services are provided from the Area/County List below. Complete the form and select Submit to receive the appropriate professional fee schedule(s).

If your provider services more than one county in the same area list, you will only need to request the fee schedule once.

If the provider services more than one county and they are not in the same area list, you will need to request the fee schedule for each area.

Important Note:

Providers contracted/affiliated with a capitated Independent Practice Association (IPA)/Medical Group or providers who are not part of a capitated IPA/Medical Group but who provide services to a member whose PCP is part of a capitated IPA/Medical Group must contact the IPA/Medical Group for instructions regarding reimbursement related questions.

Dental (DDS) providers, contracted with the Dental Network of America (DNOA, must email DNOA for reimbursement related questions or fee schedule requests.

Refer to the following area list to determine which form to use for a particular Texas county. Then access the indicated form located below the counties list.

  • City of Austin and surrounding counties

    BastropFayetteMcLennan
    BellHaysMilam
    BosqueHillRobertson
    BurlesonLeeTravis
    BurnetLeonWilliamson
    CaldwellLimestone 
    FallsMadison 
  • El Paso County

    El Paso

  • City of Lubbock and surrounding counties

    EastlandJackThrockmorton
    ErathPalo PintoWilbarger
    HaskellStephensYoung
  • Cities of Amarillo, Dallas, Fort Worth, Paris, Texarkana, Longview, Tyler and surrounding counties

    ArmstrongFoardLubbockVan Zandt
    BaileyFranklinLynnWheeler
    BaylorGarzaMarionWichita
    BowieGrayMontagueWise
    BriscoeGraysonMooreWood
    CampGreggMorrisYoakum
    CarsonHaleMotley 
    CassHallNavarro 
    CastroHansfordOchiltree 
    ChildressHardemanOldham 
    ClayHarrisonParker 
    CochranHartleyParmer 
    CollinHemphillPotter 
    CollingsworthHendersonRains 
    CookeHockleyRandall 
    CottleHoodRed River 
    CrosbyHopkinsRoberts 
    DallamHuntSherman 
    DallasHutchinsonSmith 
    Deaf SmithKaufmanSomervell 
    DeltaKentStonewall 
    DentonKingSwisher 
    DonleyKnoxTarrant 
    EllisLamarTerry 
    FanninLambTitus
    FloydLipscombUpshur
  • Cities of Midland and Odessa (and surrounding counties)

    AndrewsGlasscockMitchell
    BlancoHamiltonNolan
    BordenHowardPecos
    BrewsterHudspethPresidio
    BrownIrionReagan
    CallahanJeff DavisReeves
    CokeJonesRunnels
    ColemanKerrSan Saba
    ComancheKimbleScurry
    ConchoKinneyShackelford
    CoryellLampasasSchleicher
    CraneLlanoSterling
    CrockettLovingSutton
    CulbersonMartinTaylor
    DawsonMasonTerrell
    EctorMaverickTom Green
    EdwardsMcCullochUpton
    FisherMenardVal Verde
    GainesMidlandWard
    GillespieMillsWinkler
  • Cities of Brownsville, Corpus Christi and San Antonio (and surrounding counties)

    AransasGonzalesNueces
    AtascosaGuadalupeReal
    BanderaHidalgoRefugio
    BeeJim HoggSan Patricio
    BexarJim WellsStarr
    BrooksKarnesUvalde
    CameronKendallWebb
    ComalKenedyWillacy
    DeWittKlebergWilson
    DimmitLa SalleZapata
    DuvalLive OakZavala
    FrioMcMullen
    GoliadMedina
  • Cities of Beaumont, Houston, Nacogdoches and surrounding counties

    AndersonHarrisPolk
    AngelinaHoustonRusk
    AustinJacksonSabine
    BrazoriaJasperSan Augustine
    BrazosJeffersonSan Jacinto
    CalhounLavacaShelby
    ChambersLibertyTrinity
    CherokeeMatagordaTyler
    ColoradoMontgomeryVictoria
    FreestoneNacogdochesWalker
    Fort BendNewtonWaller
    GalvestonOrangeWashington
    HardinPanolaWharton