COVID-19 Fee Schedule/Reimbursement Update  |  view in Web Browser


Blue Review

A newsletter for physician, professional, facility, ancillary and Medicaid providers

January 2021


Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers

Read this month’s Medicaid news to learn about:

Notices & Announcements

COVID-19 Provider Preparedness Updates

As the COVID-19 crisis evolves, we’re continuing to make updates on our COVID-19 Preparedness and our COVID-19 Related News pages. Be sure to check these pages frequently for updates including COVID-19: Texas Provider FAQsAdobe Acrobat Icon and COVID-19: FAQs for Medicare ProvidersAdobe Acrobat Icon.

COVID-19 Fee Schedule/Reimbursement Update

Effective April 1, 2021, unless otherwise specified in the provider’s agreement, we will align 87426, 0224U and 0226U codes with the Centers for Medicare & Medicaid Services and local Medicare Intermediary reimbursement levels.

Read More

Tiered Payment Rate Modifiers for ABA Effective April 1, 2021

Review updates to how reimbursements will be applied using modifiers for Applied Behavioral Analysis Therapy (ABA) services effective April 1, 2021.

Read More

Billing Information on Free Bamlanivimab

Providers receiving bamlanivimab for free should not bill for the product.

Read More

Prior Authorization Has a New Home: Utilization Management

Prior authorizations are now under Utilization Management on our website. Watch for additional changes this month when Utilization Management will move under the Claims and Eligibility menu for easier flow of information related to submitting claims.

Read More

Financial Liability for Experimental, Investigational and Unproven Services

As a reminder, BCBSTX-contracted providers are not permitted to bill members for services that are considered experimental, investigational or unproven unless the member acknowledges in writing that the service(s) will not be covered by their plan and agrees to accept liability for payment prior to the services being rendered. If you have any questions, please contact your Network Management Office.

Behavioral Health

New HEDIS Tip Sheets — Behavioral Health HEDIS Measures: APM and UOP

Two new behavioral health tip sheets have been created to help you satisfy Healthcare Effectiveness Data and Information Set (HEDIS) measures and code claims appropriately.

  1. Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
  2. Use of Opioids from Multiple Providers (UOP)
Read More

Claims & Eligibility

Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding Policies describe payment rules and methodologies for CPT®, HCPCS and ICD-10 coding for claims submitted as covered services. This information is a resource for our payment policies; it is not intended to address all reimbursement-related issues. We regularly add and modify clinical payment and coding policy positions as part of our ongoing policy review process. The following have been recently added or updated:


Clinical Resources

Benefits of Collaborating with Eye Care Providers

Despite COVID-19, annual eye exams are still recommended for patients with diabetes. Review a screening recommendations summary from the American Diabetes Association which aims to improve patient outcomes.

Read MoreAdobe Acrobat Icon

Medicare Advantage Plans

New: Obtain BCBSTX Patient ID Numbers for Government Program Members via Availity

You can now use the Patient ID Finder to obtain the insurance ID and group numbers for Blue Cross Medicare AdvantageSM and Texas Medicaid members.

Read More

Network Participation

Office Based Professional Providers — Credentialing

We require physicians and other professional providers to register with the Council for Affordable Quality Healthcare’s (CAQH®) ProView for initial credentialing and recredentialing within 45 days of being rostered with CAQH. CAQH ProView is a free online service that allows providers to fill out one application to meet the credentialing data needs of multiple organizations.

Read More



Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2021 – Parts 1 & 2

These pharmacy updates include network changes, drug list revisions/exclusions/updates, dispensing limit change, Utilization Management Program changes and other Pharmacy Program updates/reminders.

1. Part 1 Adobe Acrobat Icon

2. Part 2 Adobe Acrobat Icon

Utilization Management

Update to Prior Authorization Codes for Commercial Members

We are updating our lists of procedure codes that require prior authorization for some commercial members to reflect new, replaced or removed codes. These lists are posted to our provider website.

Read More

Use AIM® ProviderPortalSM for Pre & Post-Service Reviews

As a reminder, providers need to use the AIM Specialty Health (AIM) ProviderPortalLeaving Site Icon to request prior authorizations and respond to post-service review requests required by AIM.

Read More


Health & Wellness Tips to Share

The Connect Community provides articles, blogs and videos, and visitors can ask questions and get answers. Topics include everything from improving well-being to explaining health coverage. Spanish is available.


Did You Know?

Did You Know provides an ongoing collection of articles to assist provider offices with servicing BCBSTX members. Access this month’s articlesAdobe Acrobat Icon.

BCBSTX is required to provide certain notices in all published correspondence with health care providers. For the latest updates, visit the News and Updates section of the BCBSTX provider website.

Printable PDF

View a printable PDFAdobe Acrobat Icon of the non-Medicaid information in this newsletter.

Contact Us

View our quick directory of contacts for BCBSTX.

Update Your Information

Do you need to update your location, phone number, email or other important details on file with BCBSTX or want to receive the Blue Review by email? Use our online form to request information changes.

Adobe Acrobat Icon File is in portable document format (PDF). To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader® which has a built-in screen reader. Other Adobe accessibility tools and information can be downloaded at Leaving Site Icon.

Leaving Site Icon You are leaving this website/app (“site”). This new site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association

1001 E. Lookout Drive, Richardson, TX 75082

© Copyright 2021 Health Care Service Corporation. All Rights Reserved.

Legal and Privacy  |  Unsubscribe