Updates to Claims Submission for Value Added Service - Sport/Camp Physicals Effective Jan. 1, 2024

02/15/2024

Reminder

Effective for dates of services on or after January 1, 2024, claims for value added service Sports/Camp physicals must be submitted to Blue Cross and Blue Shield of Texas using procedure code 99080 and diagnosis code Z02.5. 

Follow these steps:

• Primary Care Provider (PCP) should verify the eligibility of assigned member and confirm there has not been a physical within one year of the last physical.
• Providers must conduct a physical that meets the minimum requirements defined by a Sports or Camp Physical.
• Provider must submit claim(s) with procedure code 99080 for dates of services on or after January 1, 2024 by:

o   Electronic submission through Availity or other clearinghouses

o   Paper claims submission

Blue Cross and Blue Shield of Texas

P.O. Box 51422

Amarillo, TX 79159-1422

• Must be billed within 95 days of the date of services to receive $25.00 reimbursement.
• Providers should bill other services that were performed during the sports or camp physical on the same day on a separate claim form.

*Note: The Sport/Camp Physical Reimbursement form is no longer valid for submission of this value added benefit.

Providers, for questions or additional information, please:

• Contact your Medicaid Provider Network Representative at 1-855-212-1615
• Submit via email Texas Medicaid Network Department

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations, and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.