January 2017
Revised Effective Dates to Fee Schedule Updates for Blue Choice PPOSM and ParPlan for Applied Behavior Analysis and Related Services
On Oct. 17, 2016, Blue Cross and Blue Shield of Texas (BCBSTX) notified providers of changes in the maximum allowable fee schedule used for Blue Choice PPO and ParPlan for Applied Behavior Analysis (ABA) and related services. The effective dates for some of these changes have been postponed as noted below.
Brief descriptions of the changes:
- Effective Feb. 1, 2017, the fee schedule for CPT codes 0359T, 0370T, 0360T and 0361T specific for ABA and related services will be updated.
- Effective April 1, 2017, (not Feb. 1, 2017), the fee schedule for CPT codes 0368T, 0369T, 0371T, 0372T, 0362T, 0363T, 0364T, 0365T, 0366T, 0367T, 0373T and 0374T will be updated.
- Effective April 1, 2017, (not Feb. 1, 2017), the payable units for the following codes 0359T, 0370T, 0371T and 0372T will be updated to be limited to one unit per day.
- Effective Feb. 1, 2017, 0359T will be limited to two assessments per 12-month period.
The fee schedule changes for Blue Choice PPO are located under the General Reimbursement Information section of the Standards and Requirements tab on bcbstx.com.
BCBSTX also provides general reimbursement information policies, fee schedule request forms and fee schedule information under the General Reimbursement Information section of the Standards and Requirements tab on our website. Reimbursement changes and updates are posted under "Reimbursement Changes/Updates" in the Professional Reimbursement Schedules section. The changes will become effective 90 days from the posting date. The specific effective date will be noted for each change that is posted.
If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.
Please be advised that this reimbursement information contains confidential information proprietary to BCBSTX. The use and disclosure of this information is restricted under Texas Insurance Code Section 1301.136(b), Texas Insurance Code Section 843.321(b) and the terms of your BCBSTX agreements.