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Blue Review

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

April 2022


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

COVID-19 News and Updates
Abbott Recall of Certain Powdered Formula
Applied Behavioral Analysis for Children with Autism Spectrum Disorder — Provider Frequently Asked Questions Adobe Acrobat Icon
Update to Prior Authorization Codes for Medicaid Members Effective April 1
Independent Review Organization and External Medical Review Provider Training
Changes to Provider Demographic Updates
BCBSTX’s Shared Best Practices for Texas Health Steps
New Procedure Codes for Self-Measured Blood Pressure Monitoring Adobe Acrobat Icon
Improving the Care of Patients with Attention Deficit Hyperactivity Disorder Adobe Acrobat Icon


COVID-19 Provider Preparedness Updates

Check for continuing updates to our COVID‑19 PreparednessCOVID-19 Provider Information for ERS Participants and COVID‑19‑related news on our News and Updates page.


2021 Behavioral Health Quality Improvement Program Evaluation Executive Summary

Review an analysis and evaluation of the effectiveness and key accomplishments of our Behavioral Health Quality Improvement program.

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Supporting Mental Health

More than half of Americans will be diagnosed with a mental illness or disorder at some point in their lives, according to the Centers for Disease Control and Prevention. We encourage you to talk with our members about their mental health and recommend treatment when needed. We provide a depression screening tool to help with this conversation.

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Free Behavioral Health Webinars and Continuing Education Credit

Join us for free one-hour webinars in April (Diabetes and Behavioral Health) and May (Substance Abuse: Coordinating Care and Improving Follow‑Up). Each webinar provides one continuing medical education credit or continuing education unit. Registration is required.

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Change Coming to FEP Out-of-State Claims Processing

Currently, some out‑of‑area FEP® claims that are mistakenly submitted to a member’s Home Plan are manually forwarded to the appropriate local Plan where services were rendered. Effective June 15, we will no longer forward misdirected claims to the Host Plan for processing. Instead, we’ll deny these claims and instruct providers to resubmit them to the appropriate local Plan where the service was rendered.

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ClaimsXtenTM Quarterly Update Effective June 13, 2022

We will implement our second quarter code updates for the ClaimsXten auditing tool on or after June 13. Code updates may include additions, deletions and revisions to:

Current Procedural Terminology (CPT®) codes
Healthcare Common Procedure Coding System (HCPCS) codes
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Retinal Eye Exams and CPT II Coding

Many primary care providers (PCP) refer diabetic patients to eye care specialists for annual eye examinations. As such, we’re encouraging eye care specialists to share results routinely and promptly with PCPs. There is a specific Current Procedural Terminology CPT II code that indicates the documented communication of the eye exam findings to the PCP managing the diabetes care.

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Hospitals and Routine Services and Supplies

Routine services and supplies are generally already included by a provider in charges related to other procedures or services. As such, these items are considered non-billable for separate reimbursement. The following guidelines may assist hospital personnel in identifying items, supplies and services that are not separately billable (this is not an all‑inclusive list):

Any supplies, items and services that are necessary or otherwise integral to the provision of a specific service and/or the delivery of services in a specific location are considered routine services and not separately billable in the inpatient and outpatient environments.
All items and supplies that may be purchased over the counter are not separately billable.
All reusable items, supplies and equipment that are provided to all patients:
During an inpatient or outpatient admission are not separately billable
Admitted to a given treatment area or units are not separately billable
Receiving the same service are not separately billable


Medical Necessity Review of Observation Services

As a reminder, it is our policy to provide coverage for observation services when it is determined to be medically necessary based on the medical criteria and guidelines outlined in the MCG Care Guidelines Leaving Site Icon. Claims for observation services are subject to post‑service review, and we may request medical records for the determination of medical necessity.

Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding Policies on our website 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 policies have been recently added or updated:

CPCP013 Increased Procedural Services (Modifier 22)Adobe Acrobat Icon — Effective 3/7/2022
CPCP030 Point‑of‑Care Ultrasound Examination Policy Adobe Acrobat Icon — Effective 3/7/2022
CPCP031 Trauma Activation Adobe Acrobat Icon — Effective 3/7/2022
TXCPCP03 Surgical and Non‑Surgical Services Adobe Acrobat Icon — Effective 3/10/2022
CPCP014 Global Surgical Services — Professional Providers Adobe Acrobat Icon — Effective 6/13/2022


To support quality care, we provide information to providers and members to encourage discussions on health topics. Watch for more on health care quality in our website’s News and Updates section and on our Wellness Can’t Wait web page.

Closing Gaps in Colon Care

Screening is the most effective way to reduce the risk of colorectal cancer, according to the Centers for Disease Control and Prevention (CDC). The CDC and the U.S. Preventive Services Task Force recommend that everyone ages 45 to 75 get a screening. We encourage you to discuss screening and colon health with our members. We’ve created resources that may help.

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Update to Prior Authorization Codes for Medicare Members Effective April 1

We are changing prior authorization requirements for Medicare members to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association. A summary of changes is included.

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Verify and Update Your Information Online via Availity® Provider Data Management

The Availity Provider Data Management Tool offers providers a quick and easy way to update, validate and attest to the accuracy of their information on file with us. This multi-payer tool in Availity Essentials also allows you to make updates once and have that information sent to all participating payers.

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Pharmacy Benefits

As a reminder, certain drugs have quantity limits and/or may require prior authorization before we approve any benefits for the drug. Prior approval and quantity limits are in place to ensure we are following current medically appropriate drug guidelines.

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Regulatory & Requirements

This section includes additional items related to regulatory requirements and operational processes to assist provider offices with servicing our members. Access this month’s articlesAdobe Acrobat Icon.

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

Printable PDF

View a printable PDF Adobe Acrobat Icon of the non‑Medicaid information in this newsletter.

Contact Us

View our quick directory of contacts for BCBSTX.

Verify and Update Your Information

Verify your directory information every 90 days. Use the Provider Data Management feature on Availity® or our Demographic Change Form. You can also use this form to submit email addresses for you and your staff to receive the Blue Review each month.

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Blue Cross and Blue Shield of Texas, 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

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