October 2023
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.
