PA Code Update for Commercial Members  |  view in Web Browser


Blue Review

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

June 2022


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

COVID-19 News and Updates
COVID-19 Vaccine Informational Code Q0221 Benefit for Medicaid
Alert: Reminder to Encourage Medicaid Members to Renew Coverage Adobe Acrobat Icon
Federal Public Health Emergency Updates for 2022
Additional Update to Prior Authorization Codes for Medicaid Members, Effective July 1
Effective June 1, 2022: E0986 Is a Texas Medicaid Benefit
The Importance of Breast Cancer Screening Adobe Acrobat Icon
The Importance of Cervical Cancer Screening Adobe Acrobat Icon


COVID-19 Provider Preparedness Updates

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

ClaimsXtenTM Quarterly Update Effective Aug. 22, 2022

We will implement third-quarter code updates for the ClaimsXten auditing tool on or after Aug. 22. Code updates may include additions, deletions or revisions to Current Procedural Terminology (CPT®) codes and Healthcare Common Procedure Coding System codes.

Read More

Education Information Required for Directory

We’re collecting physician education and residency information. The Blue Cross and Blue Shield Association requires that we collect medical school and residency information from physicians (MDs and DOs) who participate in BCBSTX networks. Please respond promptly if you receive a request from us for this information.

Read More

BCBSTX Provider Record Notification Letters Will No Longer Be Mailed Effective July 1, 2022

Keep an eye on your email. To support administrative efficiencies and NPI standardization, effective July 1, we will no longer send postal mail notifications of the assigned BCBSTX Internal Provider Record ID.

Read More

Outpatient Surgery Codes with Reimbursement Increase When Performed at an Ambulatory Surgery Center

Effective back to April 1, 2022, we increased the maximum allowable standard fee schedule reimbursement for nearly 1,500 outpatient surgery services when performed at in-network Ambulatory Surgery Centers for commercial members.

Read More

Fee Schedule Update for Procedure Codes 97151 and 97152

Due to a posting error, we will implement an increase in the maximum allowable fee schedule for procedure code 97151 (effective May 1), and a reduction for procedure code 97152 (effective Aug. 1).

Read More

PEAQ Updated Methodology and FAQ

We will be releasing results of the Physician Efficiency, Appropriateness, & Quality (PEAQ) Program later this year based on previously published methodology. Additionally, we are providing an updated methodology version for future evaluation periods. Review to make sure you are adhering to these guidelines. If you have questions, please refer to the FAQ.

Read More


Watch for Behavioral Health Collaboration Requests

If you provide behavioral health services to our members, your patients may have requested to be a part of our Behavioral Health Collaboration Program. Watch for requests to collaborate with us as part of this program.

Read More

Earn Continuing Education Credit at Webinar on Avoiding Inappropriate Antibiotic Use

Watch your email for an invitation to our free webinar about preventing antibiotics overuse on June 29 from 12:15 p.m. to 1:15 p.m. CT. Doctors (MDs), physician assistants and nurse practitioners will earn one continuing medical education credit for attending.

Read More


Alert: Availity® Essentials Claim Status Tool Update

Starting on May 22, providers must use the “Select a Provider” drop-down list in the Availity Claim Status Tool for the NPI number to populate in the Member and Claim number search options. To ensure the provider information is available in the “Select a Provider” drop-down list, your Availity Administrator must add the NPI number to “Manage My Organization.”

Read More

Submit Multiple Clinical Claim Appeal Requests Online

Providers can now use the Availity Claim Status Tool to electronically initiate one clinical claim appeal request for multiple claims when it is for the same patient and denial reason.

Read More


Managing Diabetes: Closing Care Gaps

Because diabetes symptoms can develop slowly, one in five Americans don’t know they have it. You may play an important role in supporting our members through regular screenings, tests and office visits.

Read More

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:

CPCP033 Telemedicine and Telehealth ServicesAdobe Acrobat Icon — Effective 03/28/22
CPCP032 Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy Adobe Acrobat Icon — Effective 05/03/2022
CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) Adobe Acrobat Icon — Effective 08/01/2022

• Note: This policy applies ONLY to BCBSTX ERISA Administrative Services Only (ASO) plans

CPCP012 Hernia Repair Adobe Acrobat Icon — Effective 08/04/2022


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.


Additional Update to Prior Authorization Codes for Medicare Members, Effective July 1

We are changing prior authorization requirements for Medicare members to reflect new, replaced or removed CPT codes due to updates from our Utilization Management department or the American Medical Association effective July 1. A summary of changes is included.

Read More


PCP and Referral Requirements

Some BCBSTX plans require members to select a Primary Care Provider (PCP) who is responsible for referring them to specialty care providers and facilities when necessary. When making these referrals, PCPs must follow certain steps.

Read More


Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2022 – Part 1

Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some additions or drugs moving to a lower out-of-pocket payment level, revisions (drugs still covered but moved to a higher out-of-pocket payment level) and/or exclusions (drugs no longer covered) were made to BCBSTX drug lists. Your patient(s) may ask you about therapeutic or lower cost alternatives if their medication is affected by one of these changes. View the Pharmacy Program Updates Effective July 1, 2022Adobe Acrobat Icon.


Prior Authorization Code Update Effective Aug. 1 for Commercial Members

In August, we will update our lists of procedure codes requiring prior authorization for some commercial members to reflect new, replaced or removed codes due to updates from our Utilization Management department or the American Medical Association.

Read More

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.

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.

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

© Copyright 2022 Health Care Service Corporation. All Rights Reserved.

Legal and Privacy  |  Unsubscribe