Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

November 2016

Urinary Drug Test (UDT) Fee Schedule Update

Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the Urinary Drug Test (UDT) series CPT codes maximum allowable fee schedule used for Blue Choice PPOSM, Blue PremierSM, Blue EssentialsSM (formerly HMO Blue TexasSM), Blue Advantage HMOSM and ParPlan members effective Feb. 1, 2017.

Periodically, BCBSTX reviews claims submitted by providers to help ensure that benefits provided are for services that are included in our members’ benefit plans and meet BCBSTX’s guidelines.

Below is a brief description of the change:

Professional claims submitted on a HCFA 1500 for Urinary Drug Test (UDT) 80000 series CPTs and billed with or without the CMS specified G code replacements on the same HCFA 1500 claim, will not  be reimbursed by BCBSTX effective Feb. 1, 2017. However, the CMS specified G HCPCS code replacements for the UDT 80000 series codes (see grid below) will be considered for reimbursement according to our fee schedule posted in the General Reimbursement Information section.

HCPCS Codes

Drug Test Class

G0480

1-7

G0481

8-14

G0482

15-21

G0483

22 or more

BCBSTX provides general reimbursement information policies, fee schedule request forms and fee schedule information under the General Reimbursement Information section on the provider website. Reimbursement changes and updates are posted under "Reimbursement Changes/Updates" in the Professional Reimbursement Schedules section. The changes will not become effective until at least 90 days from the posting date. The specific effective date will be noted for each change that is posted.

Please remember that if services are rendered directly by the provider, the services may be billed by the provider. However, if the provider does not directly perform the service and the service is rendered by another provider, only the rendering provider can bill for those services.

For additional information, please refer to both the monthly Blue Review newsletter and Provider Manuals. Please be advised that the reimbursement information being disclosed within this notification 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, Blue Choice PPO, Blue Premier, Blue Essentials formerly HMO Blue Texas, and Blue Advantage HMO agreements.

For ancillary provider questions, please feel free to email your questions to bcbstxancillarycontracting@bcbstx.com or if you need additional information, please contact your Network Management Representative.