Texas Senate Bill 1040 Prohibits Organ Transplants Associated with China

Since Sept. 1, 2023, we do not provide medical coverage for human organ transplants if the operation was performed or if the organ was sold or donated from China or a country known to have participated in organ harvesting.

ClaimsXten^TM Quarterly Update Effective Dec. 9, 2024

We will implement fourth-quarter code updates for the ClaimsXten auditing tool on or after Dec. 9, 2024. These quarterly code updates aren’t considered changes to the software version. Code updates may include additions, deletions and revisions to:

• Current Procedural Terminology (CPT^®) codes
• Healthcare Common Procedure Coding System (HCPCS) codes

Register for a Coding Webinar on Coagulation Defects and Other Hematological Disorders

Attend a free course to learn how to code coagulation defects and other hematological disorders.

Updated Claims Referral Form for American Indian/Alaska Native Limited Cost-Share Plans

We’ve updated the claims referral form that providers use to refer Indian Health, Tribal and Urban Indian members in limited cost-sharing plans to non-Indian Health, Tribal and Urban Indian providers.

New Laboratory Claims Review for Certain ASO Groups

Beginning Jan. 1, we will implement new laboratory clinical payment and coding policies for some outpatient services (pre-service and post-service) for certain ASO groups.

Fee Schedule Updates

Reimbursement changes and updates for commercial HMO and PPO providers are posted under the Standards and Requirements/General Reimbursement Information/Reimbursement Schedules and Related Information/Professional Schedules section on our provider website.  

Changes resulting in a decrease will become effective no less than 90 days from the posting date. The specific effective date will be noted for each change. To view this information, visit the General Reimbursement Information section on our provider website. The Drug CPT/HCPCS Fee Schedule is updated quarterly on March 1, June 1, Sept. 1 and Dec. 1. The NDC Fee Schedule is updated monthly.

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. We may add and modify clinical payment and coding policies. The following policy was added or updated:

• Annual Review: Unlisted/Not Otherwise Classified (NOC) Coding Policy, Effective Aug. 29, 2024