BCBSTX Implements Changes in Maximum Allowable Fee Schedule

Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the maximum allowable fee schedule used for Blue Choice PPO^SM, HMO Blue Texas^SM, Blue Advantage HMO^SM (Independent Provider Network and THE Limited Network only), and ParPlan effective Nov. 1, 2015.

Changes will be implemented in the maximum allowable fee schedules used for the Blue Cross Medicare Advantage PPO^SM and Blue Cross Medicare Advantage HMO^SM effective Jan. 1, 2016.

• The methodology used to develop the maximum allowable fee schedule for Blue Choice PPO, HMO Blue Texas and Blue Advantage HMO  will be based on 2015 CMS values posted on the CMS website as of Jan. 16, 2015, for those services for which the BCBSTX reimbursement is based on CMS values.
   
• Geographic Practice Cost Indices (GPCIs) will not be applied to the relative values so the relative values will not differ by Medicare locality.
   
• Blue Choice PPO, HMO Blue Texas, Blue Advantage HMO and ParPlan relative values will consider the site of service where the service is performed (facility or non-facility).
   
• The CPT/HCPCS Fee Schedule will be updated quarterly on March 1, June 1, Sept. 1 and Dec. 1 each year.
   
• The NDC Fee Schedule will be updated monthly.

BCBSTX provides general reimbursement information policies, request forms for allowable fees and fee schedule information. To view this information, visit the General Reimbursement Information section on the BCBSTX provider website. If you would like to request a sample of maximum allowable fees or if you have any other questions, please contact your Network Management office.

Reimbursement changes will be posted under "Reimbursement Changes and Updates" in the Reimbursement Schedules section on our provider website. 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.