July 2017
Fee Schedule Updates Effective Oct. 1
Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the maximum allowable fee schedule used for Blue Choice PPOSM, Blue EssentialsSM, Blue PremierSM, Blue Advantage HMOSM and ParPlan effective Oct. 1, 2017. The changes include:
- The methodology used to develop the maximum allowable fee schedule for these plans will be based on 2017 Centers for Medicare and Medicaid Services (CMS) values as posted on their website for the services in 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 General Reimbursement Information section of BCBSTX’s provider website.
- Reimbursement changes and updates will be posted under "Reimbursement Changes/Updates" in the Reimbursement Schedules section.
- The specific effective date will be noted for each change that is posted.
- The conversion factor for certain surgical codes may vary by place of service for ambulatory surgical center and outpatient hospital.
- Blue Choice PPO, Blue Essentials, Blue Premier and Blue Advantage HMO:
- Will consider the site of service where the service is performed.
- The multiple procedure payment will be changing on the professional component of certain diagnostic imaging procedures. This change applies to services billed as professional component only or global for the procedures listed on the website. The highest priced procedure will be reimbursed at 100 percent of the allowable and each additional procedure – when performed during the same session on the same day – will be reimbursed at 95 percent (previously 75 percent) of the allowable.
If you would like to request a sample of maximum allowable fees or if you have any questions, please contact your Network Management office.