April 2019

New Clinical Payment and Coding Policy Updates

Blue Cross and Blue Shield of Texas (BCBSTX) has implemented clinical payment and coding policies based on criteria developed by specialized professional societies and national guidelines (e.g., MCG^TM), the Centers for Medicare & Medicaid Services (CMS) Provider Reimbursement manual and others (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.

Here are the latest updates:

• Effective Feb. 18, 2019, the Increased Procedural Services (Modifier 22) policy was updated.
• Effective March 18, 2019, the following policies were updated:
• Applied Behavior Analysis for Autism Spectrum Disorders
• Global Surgical Package
• Hernia Repair
• Effective June 22, 2019, the Multiple Surgery Procedures policy will be added.

Refer to the Clinical Payment and Coding Policies section on the BCBSTX provider website for additional information.

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