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for Providers

October 2023

Reminder for Billing Point-Of-Use Convenience Kits

Blue Cross and Blue Shield of Texas (BCBSTX) regularly reviews claims submitted by providers to help ensure that benefits provided are for services that are included in our members’ benefit plans and meet our guidelines.

Some providers are submitting claims for point-of-use convenience kits used in the administration of injectable medicines. In addition to the injectable medicine, these prepackaged kits include supply items, such as alcohol prep pads, cotton balls, disposable sterile medical gloves, povidone-iodine swabs, adhesive bandages and gauze. As a reminder, only the drug component of the kit is reimbursable to the provider.

BCBSTX periodically checks the pricing of these kits to manage costs. Often, the cost of these convenience kits is more than the cost of its components when purchased one item at a time. These non-drug supplies are considered as part of the practice expense for the procedure performed and no added compensation is warranted. Reimbursement for these point-of-use convenience kits may be updated based upon the FDA-approved drug component.

Remember to provide the most appropriate care in the most cost-effective manner.

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The listing of any particular drug or classification of drugs is not a guarantee of benefits. The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.