2023 Disclosure Notices

Blue Cross and Blue Shield of Texas (BCBSTX) uses the BCBSTX Provider website to publish disclosure notices. The website allows BCBSTX to disclose changes in a timely and comprehensive manner.

Disclosure notices are subject to being posted either 60 or 90 days in advance of the effective date of the change with as much notice as is practicable and in compliance with applicable state or federal law.

Disclosure notices can include but are not limited to fee schedule updates and reimbursement policies, clinical payment and coding policies, provider manuals and/or benefit and medical policy changes which may impact claim payments.

If you need assistance accessing this information on the BCBSTX Provider website, please contact your Network Management office.

Note —Disclosures related to Clinical Payment and Coding Policies (CPCP) will indicate CPCP and the policy number followed by the title of the policy.
     
Notices Posted Effective
Prior Authorization Code Changes for Commercial Members Effective Jan. and April 2024 12/15/2023 Updated 1/8/2024 04/01/2024
CPCP033 Telemedicine and Telehealth/Virtual Health Care Services Policy Update Effective 03/08/2024 12/07/2023 03/08/2024
CPCP020 Drug Testing Clinical Payment and Coding Update Effective 03/07/2024 12/06/2023 03/07/2024
CPCP004 NICU Level of Care Authorization and Reimbursement Policy Update Effective 03/06/2024 12/05/2023 03/06/2024
CPCP030 Point-of-Care Ultrasound Updated Effective 03/06/2024 12/05/2023 03/06/2024
TRS is Moving Certain Services to Recommended Clinical Review 11/30/2023 03/01/2024
Three New ClaimsXtenTM Rules to be Implemented March 2024 11/29/2023 03/01/2024
Category Removals from eviCore and other Updates to Prior Authorization Codes for Medicare Advantage Members, Effective Jan. 1, 2024 10/26/2023 01/01/2024
Musculoskeletal, Cardiology Expansion and other Prior Authorization Code Changes for Commercial Members, Effective Jan. 1, 2024 10/26/2023 01/01/2024
Fee Schedules Update Effective February 1, 2024 10/24/2023 02/01/2024
CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services Updated Effective 01/15/2024 10/16/2023 01/15/2024
Medicare Advantage Behavioral Health Mid-Level Fee Schedule Increase - Effective  Jan. 1, 2024  10/11/2023 01/01/2024
Medicare Advantage Behavioral Health Services Update 10/06/2023 01/01/2024
2024 Expansion Blue Cross Medicare Advantage - Effective  Jan. 1, 2024 09/28/2023 01/01/2024
MyBlue Health Network Expansion, Effective Jan.1, 2024
09/20/2023 01/01/2024
CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services Update 12/01/2023 08/31/2023 12/01/2023
Reimbursement Change for Inpatient DRG Claims When Patients Are Transferred Early  08/15/2023 11/20/2023
Update to Prior Authorization Codes for Medicare Members, Effective Oct. 1, 2023 07/24/2023 10/01/2023
Claim Editing Changes for Emergency Department Services Coming Nov. 1, 2023 07/24/2023 11/01/2023
Revised CPCP003 and New CPCP042 for Emergency Department Evaluation and Management Services Coding for Facility and Professional Services, Effective 10/25/2023 07/24/2023 10/25/2023
Introducing Smart RxAssist via HealthSmartRx® 07/18/2023 10/16/2023
CPCP031 Trauma Activation - Facility Services Updated Effective 10/18/2023 07/17/2023 10/18/2023
Update to Prior Authorization Codes for Commercial Members, Effective Oct. 1, 2023  07/10/2023 10/01/2023
CPCP014 Global Surgical Package – Professional Providers Updated Effective 10/01/2023 06/30/2023 10/01/2023
Update to Prior Authorization Exemption Clinical Guidelines 06/29/2023 09/01/2023
CPCP021 Laboratory Panel Billing Updated Effective 09/28/2023 06/27/2023 09/28/2023
New CPCP041 Sepsis Policy Effective 09/06/2023 06/06/2023 09/06/2023
CPCP011 Applied Behavioral Analysis Updated Effective 09/01/2023 06/01/2023 09/01/2023
CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services Update 09/01/2023 05/31/2023 09/01/2023
CPCP001 Observation Services Policy Updated Effective 09/01/2023 05/31/2023 09/01/2023
New Clinical Payment and Coding Policy CPCP039 Outpatient Facility Service(s) Overlapping During an Inpatient Stay 05/22/2023 09/01/2023
CPCP0012 Hernia Repair Updated Effective 08/18/2023 05/17/2023 05/18/2023
CPCP0013 Increased Procedural Services (Modifier 22) Effective 08/15/2023 05/15/2023 08/15/2023
CPCP034 Unbundling Policy – Professional Providers Effective 08/15/2023 05/15/2023 08/15/2023
ClaimsXten™ Quarterly Update Effective August 21, 2023 05/10/2023 08/21/2023
New CPCP038 Outpatient Services Prior to an Inpatient Admission, Three-day Payment Policy Effective 08/01/2023 04/17/2023 08/01/2023
Update to Prior Authorization Codes for Commercial Members, Effective July 1, 2023 04/03/2023 07/01/2023
CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services Update 07/01/2023 03/31/2023 07/01/2023
Update to CPCP010 Anesthesia Services Effective 06/26/2023 03/24/2023 06/26/2023
New CPCP040 Physical Medicine and Rehabilitation Services Effective 06/26/2023 03/24/2023 06/26/2023
Update to CPCP016 Chiropractic Care Services Effective 06/26/2023 03/24/2023 06/26/2023
Update to CPCP023 Modifier Reference Effective 06/26/2023 03/24/2023 06/26/2023
Changes to CPCP027 Inpatient Readmissions Policy Effective 07/01/2023 03/15/2023 07/01/2023
Prior Authorization and Claim Reconciliation for Neonatal Intensive Care Unit Services Effective April 16, 2023 - Updated effective date

12/20/2022 -  Updated 02/22/23

 

04/16/2023
CPCP022 Pneumatic Compression Devices – Outpatient Use Update – Effective 05/17/2023 02/16/2023 05/17/2023
CPCP017 -Wasted/Discarded Drugs and Biologicals Policy – Effective 05/16/2023 02/15/2023 05/16/2023
Update to Prior Authorization Codes for Medicare Members, Effective April 1, 2023 01/30/2023 04/01/2023
Correction - Prior Authorization Codes for Commercial Members Updated Effective April 1, 2023 01/17/2023 04/01/2023
CPCP026 Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding Update Effective 04/05/2023  01/04/2023 04/05/2023
ClaimsXten™ Quarterly Update Effective April 17, 2023   01/03/2023 04/17/2023