08/08/2024
What’s happening
Effective September 1, 2024, Blue Cross and Blue Shield of Texas will enhance our claims editing and review process to help ensure accurate coding and reimbursement of services. Below is a list of policies that will be affected once the new edits go into effect.
Medicaid – Texas State Policy |
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Topic |
Description |
Reason Code |
Physical Therapy, Occupational Therapy, and Speech Therapy |
Limited 97012 – 97028 (application of Modality) 97150 (Group therapeutic procedure) 97799 (unlisted physical medicine/rehab service) to one unit per day when billed with modifier GP (physical therapy) by any provider |
ADJUN – Adjusted Units Because They Exceeded The Amount Allowed |
Medicaid – Procedure Code Definition Policy |
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|
Topic |
Description |
Reason code |
ICD-10 PCS Procedure Code Definition |
Deny procedures based on ICD-10-PCS procedure code definition. |
PINLS- Procedure Inconsistent With Length of Stay |
Questions
Providers, for questions or additional information, please:
- Contact your Medicaid Provider Network Representative at 1-855-212-1615
- Submit via email to TexasMedicaidNetworkDepartment@bcbstx.com