Prior Authorization Codes Updated for Medicare Members, Effective July 1  |  view in Web Browser


Blue Review

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

May 2022


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

COVID-19 News and Updates
Texas Medicaid Claims Editing Enhancements Effective July 26, 2022 Adobe Acrobat Icon
Update to Prior Authorization Codes for Medicaid Members, Effective July 1
Texas Health Steps, HEDIS® and Bright FuturesTM Required Components Adobe Acrobat Icon
Do You Know Your BCBSTX Medicaid Provider Representative? Adobe Acrobat Icon
BCBSTX Disease Management for Medicaid
Supporting Mental Health
New Episodes of Medicaid Simplified: A Podcast for Texas Medicaid Providers


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.

Update: New BCBSTX Lab Policies and Laboratory Management Program with Avalon Postponed

The May 1 launch of our new lab policies and laboratory management program with Avalon Healthcare Solutions has been postponed. Please watch our News and Updates page for future updates about this program.


Follow-Up Care for Substance Abuse Disorders

More than 40 million people ages 12 and older in the U.S. needed treatment for a substance abuse disorder in 2020, but only about 2.6 million received it, according to the latest survey by the Substance Abuse and Mental Health Services Administration. We encourage you to talk with our members about the signs of substance abuse disorder and urge them to seek help when appropriate.

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Coding for Breast Augmentation and Removal for Gender Affirming Surgery

The American Medical Association (AMA) recently updated its guidance for the correct CPT® codes to use when filing claims for breast removal and breast augmentation as part of gender reassignment surgeries. We have updated our system to align with AMA and American Academy of Professional Coders billing guidance.

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CPT Category II Codes Can Help Close Care Gaps

Using the proper Current Procedural Terminology (CPT) Category II codes when filing claims can help streamline your administrative processes and ensure gaps in care are closed.

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Advisory on Telemedicine Telehealth Services – Place of Service (POS) Codes

We have updated our telemedicine commercial reimbursement guidelines due to recent Centers for Medicare & Medicaid Services updates. For commercial member claims, providers should continue using POS 02 with telehealth claims even when telehealth is provided in a patient’s home. Claims using POS 10 may be rejected.

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Enrollee Notification Form Required for Out-of-Network Care for Blue Choice PPOSM and Blue Advantage HMOSM (for Blue Advantage PlusSM)

When a network provider refers a Blue Choice PPO or Blue Advantage HMO member to an out-of-network provider for non-emergency services (when such services are available through an in-network provider), appropriate forms must be filled out and filed.

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Change Coming to FEP Out-of-State Claims Processing
ClaimsXtenTM Quarterly Update Effective June 13, 2022


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:

CPCP006 Preventive Services PolicyAdobe Acrobat Icon — Effective 04/01/2022
CPCP034 Unbundling Policy – Professional Providers Adobe Acrobat Icon — Effective 04/11/2022
CPCP021 Laboratory Panel Billing Adobe Acrobat Icon — Effective 04/14/2022
CPCP023 Modifier Reference Policy Adobe Acrobat Icon — Effective 07/15/2022


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.

Supporting Care During and After Pregnancy

For pregnant and postpartum women, care visits can set the stage for their and their infants’ long-term well-being, according to the American College of Obstetricians and Gynecologists. We encourage you to discuss timely care with our members during and after pregnancy. We have resources that may help.

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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 codes due to updates from Utilization Management or the American Medical Association. A summary of changes is included.

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Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM Annual Health Assessment (AHA) Incentive FAQs – 2022

Review FAQs regarding this year’s AHA incentive, such as who is eligible and how the incentive works.

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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2022 – Part 2

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 (new to coverage) and/or coverage tier changes (drugs moved to a lower out-of-pocket payment level) will be made to our drug lists. Your patients may ask you about therapeutic or lower cost alternatives if their medication is affected by one of these changes.

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Patient Appointment Access Standards

Make sure you’re up to date on our patient access standards, which providers are required to follow.

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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

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