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.