Blue Cross and Blue Shield of Texas (BCBSTX) increases the maximum allowable standard fee schedule reimbursement for certain outpatient surgery services when performed at in-network Ambulatory Surgery Centers (ASC) for commercial members*.
Surgery performed in a hospital can cost nearly three times more than an ASC. A sizable portion of this additional cost is passed on to patients through coinsurance or deductibles.
This initiative creates an opportunity to increase your reimbursement by 15%-50% on each qualifying procedure while allowing patients to receive the same quality of care they would get in a hospital but at a significantly lower cost. While this opportunity maximizes the benefit for the patient, it also aligns incentives for eligible physicians to provide care in the most cost-effective manner.
What’s Covered?
Codes that qualify for this program fall within the following categories:
| Auditory | Endooscopy | Musculoskeletal or Orthopedic |
| Bariatric | Eye | Neurology |
| Cardiovascular | General Surgery | Reprorductive |
| Colonoscopy | Gynecologic | Respiratory |
| Digestive | Integumentary | Urology |
| Endocrine | Lymphatic |
You can reference the full code list HERE.
More Information
To determine if the increase applies to the services you perform, participating providers may use the Fee Schedule Viewer tool via Availity Essentials and electronically receive the incentive price allowance, as applicable, for up to 20 procedure codes at a time by selecting Other Place of Service.
*Please note, this does not apply to BCBSTX Medicare Advantage or Medicaid members.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.