2024 Disclosure Notices

BCBSTX uses the BCBSTX Provider website to publish disclosure notices. The website allows BCBSTX to disclose changes in a timely and comprehensive manner.

Disclosure notices are subject to being posted either 60 or 90 days in advance of the effective date of the change with as much notice as is practicable and in compliance with applicable state or federal law.

Disclosure notices can include but are not limited to fee schedule updates and reimbursement policies, clinical payment and coding policies, provider manuals and/or benefit and medical policy changes which may impact claim payments.

Disclosures related to Clinical Payment and Coding Policies (CPCP) will indicate CPCP and the policy number followed by the title of the policy.

If you need assistance accessing this information on the BCBSTX Provider website, please contact your Network Management office.

DISCLOSURE NOTICE POSTED EFFECTIVE
CPCP036 Paravertebral Facet Injection Procedure Billing & Coding Policy Updated Effective 02/13/2025 11/12/2024 02/13/2025
CPCP008 Psychological and Neuropsychological Testing Updated Effective 02/13/2025 11/12/2024 02/13/2025
CPCP020 Drug Testing Clinical Payment and Coding Policy Updated Effective 02/13/2025 11/12/2024 02/13/2025
Prior Authorization Code Updates for Medicare Advantage Members Effective January 1, 2025 10/31/2024 01/01/2025
CPCP011 Applied Behavior Analysis – Effective 02/01/2025 10/29/2024 02/01/2025
MyBlue HealthSM Network Expansion Effective Jan. 1, 2025 10/15/2024 01/01/2025
Prior Authorization Code Changes for Commercial Members Effective Jan. 1, 2025 10/03/2204 01/01/2025
Site of Care Utilization Management Review for Advanced Imaging Effective Jan. 1, 2025 09/30/2024 01/01/2025
Medical Transportation Utilization Management for Some Members Updated Effective Jan. 1, 2025 09/30/2024 (Updated 11/1/2024) 01/01/2025
Updates Coming to Behavioral Health Substance Use Disorder Criteria for Utilization Management  09/30/2024 01/01/2025
New Laboratory Claims Review for Certain ASO Groups - Jan. 1, 2025 09/30/2024 01/01/2025
ClaimsXten™ Quarterly Update Effective Dec. 9, 2024  09/06/2024 12/09/2024
CPCP026 -Therapeutic, Prophylactic, Diagnostic, Injection and Infusion Administration Coding Updated Effective 11/21/2024 08/20/2024 11/21/2024
Revised Coding for Consultation Services – See our Clinical Payment and Coding Policy CPCP024 Evaluation and Management Coding – Professional Services 08/15/2024 11/18/2024
Additional Claim Processing Enhancements for ERS Plans Coming Soon 08/02/2024 (updated 10/3/2024, 10/29/2024) Postponed - TBD
Prior Authorization Code Updates for Medicare Advantage Members, Effective Oct. 1, 2024 07/26/2024 10/01/2024
CPCP012 Hernia Repair Updated Effective 10/10/2024 07/09/2024 10/10/2024
Prior Authorization Code Changes for Commercial Members Effective Oct. 1 06/28/2024 10/01/2024
NICU Utilization Management Update Effective Sept. 1, 2024, for ERS Plans 06/21/2024 09/01/2024
TXCPCP03 Surgical and Non-Surgical Services Updated Effective 09/06/2024 06/05/2024 09/06/2024
Changing Prior Authorization to Recommended Clinical Review Effective Sept. 1 for TRS Participants -Updated 05/31/2024 (updated 8/27/2024) 09/01/2024
Utilization Management Update Including Change to Recommended Clinical Review Effective Sept. 1, 2024, for ERS Plans  05/31/2024 09/01/2024
Update: Our Revised Clinical Payment and Coding Policy for Anesthesia Services now Effective Aug. 14, 2024 02/29/2024 (Updated 05/30/2024) 08/14/2024
Updated PEAQSM Methodology Is Now Available 05/29/2024 05/30/2026
Claim Processing Enhancements for ERS Effective Sept. 1, 2024 05/28/2024 (Updated 08/23/2024) 09/01/2024
CPCP029 Medical Record Documentation Updated Effective 07/24/2024 04/23/2024 07/24/2024
Prior Authorization Code Updates for Medicare Advantage Members, Effective July 1, 2024 04/17/2024 07/01/2024
Prior Authorization Code Changes for Commercial Members Effective 07/01/2024 03/29/2024 07/01/2024
CPCP025 Corrected Claim Submission Updated Including Changes for Late/Added Charges 03/28/2024 07/01/2024
CPCP028 Non-Reimbursable, Experimental, Investigational and/or Unproven Services (EIU) Update - Effective 07/01/2024 03/26/2024 07/01/2024
See Our Revised Clinical Payment and Coding Policy for Billing Anesthesia Services Effective 06/01/2024 (Updated Effective date to 08/14/2024 on 5/30/2024)
02/29/2024(Updated 05/30/2024)
Changed from 06/01/2024 to 08/14/2024
CPCP033 Telemedicine and Telehealth/Virtual Health Care Services Policy Updated Effective 05/01/2024 02/29/2024 05/01/2024
Claim Editing Changes for Emergency Department Services 07/24/2023 (Updated 02/28/2024) 04/01/2024
CPCP028 Non-Reimbursable, Experimental, Investigational and/or Unproven Services (EIU) Update- Effective 05/15/2024 02/14/2024 (Updated 03/26/2024) 05/15/2024
Recommended Clinical Review Procedure Code List Changes for Commercial Members Effective May 15, 2024 02/14/2024 05/15/2024
Introducing Smart RxAssist via HealthSmartRx® 01/26/2024 05/01/2024
CPCP023 Modifier Reference Policy Update– Effective 04/19/2023 01/18/2024 04/19/2024
Prior Authorization Code Updates for Medicare Advantage Members Effective April 1, 2024 01/11/2024 04/01/2024
Update to Prior Authorization Code Changes for Commercial Members Effective April 1, 2024 01/08/2024 04/01/2024