09/30/2024
Beginning Jan. 1, 2025, Blue Cross and Blue Shield of Texas will implement new reimbursement policies for certain laboratory, services, tests and procedures for some Administrative Services Only members. You can view our applicable Laboratory Management Clinical Payment and Coding Policies here. A list of impacted ASO groups is coming soon on our website.
Affected claims: This lab program includes a review of claims prepayment and post-service for the following outpatient laboratory claims:
- Outpatient laboratory claims with dates of service beginning Jan. 1, 2025
- Claims for services performed in an outpatient setting (typically office, hospital outpatient or independent laboratory)
- Any claims that meet criteria relevant to one or more of the applicable laboratory services
- Applicable to specific ASO group members
Ordering providers should review the applicable Laboratory Management Clinical Payment and Coding policy when requesting lab services.