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
•	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
•	The Importance of Cervical Cancer Screening

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.

ClaimsXten^TM 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.

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.

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.

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.

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).

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.

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.

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.

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.”

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.

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.

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 Services — Effective 03/28/22
•	CPCP032 Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy — Effective 05/03/2022
•	CPCP028 Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) — Effective 08/01/2022 • Note: This policy applies ONLY to BCBSTX ERISA Administrative Services Only (ASO) plans
•	CPCP012 Hernia Repair — 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.

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.

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, 2022.

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.

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