Attend a webinar on coding for morbid and severe obesity

Blue Review

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

August 2023


Access all 2023 news and updates for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers. Highlights include:

Update to Prior Authorization Codes, Effective Oct. 1
Required Documents for Authorization of Day Activity and Health ServicesAdobe Acrobat Icon
Next Steps and Timeline for Transition to HHAeXchange
Provider Depression Disorder Prescribing
Provider Impact on Maternal Infant Health
Alert: Medicaid Members Can’t Be Balance Billed
Reminder: Providers Help Our Members Get Ready for RedeterminationAdobe Acrobat Icon
Reminder: Survey to Assess Medicaid Provider ExperiencesAdobe Acrobat Icon
Statin Therapy for Patients with Cardiovascular Disease and Diabetes
Reminder: New Form for OB/GYN Compliance Challenges with Prenatal Appointment AvailabilityAdobe Acrobat Icon


Free Tools & Resources Available via Availity® Essentials

Availity is a secure, web-based, full-service information portal and a claims clearinghouse that provides real-time transactions at no charge.

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Reminder: Physician Performance Insight (PPI) Reports are Coming Soon

On or around Aug. 21, PPI reports will be available. Review who should retrieve their reports, how they could impact you and how to request a reconsideration. After PPI reports are posted, our Physician Efficiency, Appropriateness and QualitySM Team will offer PEAQ 101 webinars for physicians to learn more about the program.

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Provider Depression Disorder Prescribing

Help close gaps in care for your patients living with depression by reviewing screening and treatment options with them.

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Antidepressant Medical Management

Studies show that more than half of patients suffering from major depression don’t take their medications as prescribed. As such, we’re providing a checklist to help you help your patients understand the importance of medication adherence, opportunities for shared decision-making and follow-up appointments.

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Technical and Professional Components

Modifier 26 denotes professional services for lab and radiological services. Modifier TC denotes technical components for lab and radiological services. These modifiers should be used in conjunction with the appropriate lab and radiological procedures only. Note: When a health care provider performs both the technical and professional services for a lab or radiological procedure, they must submit the total service, not each service individually.


Statin Therapy for Patients with Cardiovascular Disease and Diabetes

You can help ensure quality care for our members who have cardiovascular disease and diabetes by following guidelines on statin therapy from the National Committee for Quality Assurance.

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Clinical Payment and Coding Policy Updates

Our website’s Clinical Payment and Coding Policies 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 and does not address all reimbursement-related issues. During our policy review process, we regularly add and modify clinical payment and coding policy positions. The following policies were added or updated:

CPCP006 Preventive Services Policy Update, Effective 07/01/2023
CPCP021 Laboratory Panel Billing Updated, Effective 09/28/2023
CPCP014 Global Surgical Package – Professional Providers Updated, Effective 10/01/2023
CPCP031 Trauma Activation – Facility Services Updated, Effective 10/18/2023


Webinar on Coding for Morbid and Severe Obesity

Join us for one of two webinars on coding for morbid and severe obesity. Topics include:

Obesity classification levels based on body mass index
ICD-10-CM guidelines and case studies
Closing gaps in care for patients
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To support quality care, we provide information to providers and members to encourage discussions on health topics. Watch for more on health care quality on our website’s News and Updates section and on our Delivering Quality Care web page.

In-Home Test Kits for Colorectal Cancer Screening

FYI: We’re providing in-home Fecal Immunochemical Test kits to certain members who (based on our data) need a colorectal cancer screening. If any of your patients receive a kit, please encourage them to use it.

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Colorectal Cancer Screening Options and Statistics: Get the Conversation Started Today

The second of a four-part series on Colorectal Cancer (CRC) Screenings
Almost all major guidelines recommend CRC screenings start for average risk individuals at age 45 and continue through to age 75. But some populations may be reluctant to participate, so we’re providing recommendations to get the conversation started with these patients.

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Update to Prior Authorization Codes for Medicare Members, Effective Oct. 1, 2023

We’re updating our lists of codes that require prior authorization to reflect new, replaced or removed codes. Changes effective Oct. 1 include:

Addition of specialty drug codes
Addition of lab codes
Removal of lab codes
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Verify and Update Your Information

As a reminder, if you’ve had a change in location, phone number, email or other important details, you must notify us within 90 days via Availity Essentials (under Provider Data Management) or our Demographic Change Form. Your demographic information must be current so our members and other providers can locate you in our Provider Finder® tool.


Pharmacy Program Quarterly Update, Part 2: Changes Effective July 1, 2023

Review important pharmacy benefit reminders, drug list and dispensing limit changes, and Utilization Management program changes.

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Introducing Smart RxAssist via HealthSmartRx®

We’re working with HealthSmartRx to implement the Smart RxAssist program for eligible Teacher Retirement System of Texas participants effective Oct. 16, 2023. Learn what Smart RxAssist is, its benefits and how it works.

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Update to Prior Authorization Codes for Commercial Members, Effective Oct. 1, 2023

We’re updating our lists of codes that require prior authorization to reflect new, replaced or removed codes. Changes effective Oct. 1 include:

Addition of specialty pharmacy codes to be reviewed by BCBSTX
Removal of a radiation oncology drug code previously reviewed by Carelon Medical Benefits Management
Addition of a musculoskeletal joint and spine code to be reviewed by Carelon
Replacement of genetic testing codes reviewed by Carelon
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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 PDFAdobe 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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