Updates to Clinical Payment and Coding Policies

May 28, 2018

Updated: 06/04/2018

Blue Cross and Blue Shield of Texas (BCBSTX) has implemented clinical payment and coding policies based on criteria developed by specialized professional societies, national guidelines (e.g. MCG^TM) and the Centers for Medicare & Medicaid Services (CMS) Provider Reimbursement Manual. Additional sources are used and can be provided upon request. The clinical payment and coding guidelines are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.

The following policies are being implemented or have been updated and will be effective Sept. 1, 2018:

• Chiropractic Services
• Observation Services Tool for Applying MCG Care Guidelines

The following policies have been updated and changes will be effective June 1, 2018:

• Applied Behavior Analysis for Autism Spectrum Disorders
• Evaluation and Management of Emergency Department Coding
• Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy

The following policy has been updated and changes will be effective June 28, 2018:

• Preventive Services Policy

Refer to Clinical Payment and Coding Policies under Standards and Requirements on the provider website to review the current CPCPs.

If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.

MCG care guidelines 20th Edition Copyright © 2016 MCG Health, LLC