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
•	Update to Prior Authorization Codes for Medicaid Members, Effective July 1
•	Texas Health Steps, HEDIS® and Bright FuturesTM Required Components
•	Do You Know Your BCBSTX Medicaid Provider Representative?
•	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 Preparedness, COVID-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.

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.

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.

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.

Enrollee Notification Form Required for Out-of-Network Care for Blue Choice PPO^SM and Blue Advantage HMO^SM (for Blue Advantage Plus^SM)

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.

Reminders:

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 Policy — Effective 04/01/2022
•	CPCP034 Unbundling Policy – Professional Providers — Effective 04/11/2022
•	CPCP021 Laboratory Panel Billing — Effective 04/14/2022
•	CPCP023 Modifier Reference Policy — 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.

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.

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.

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.

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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