Blue Cross and Blue Shield of Texas (BCBSTX) applies a multiple procedure payment reduction to diagnostic cardiovascular and ophthalmology procedures billed for the same patient on the same day.
The payment reduction applies to modifier TC-only services and to the technical component portion of global services. It does not apply to professional component (modifier 26) services.
BCBSTX will fully pay for the technical component service with the highest allowable amount under the payer’s fee schedule. For subsequent services performed by the same physician for the same patient on the same day, it will pay a percentage of the technical component allowable:
- For cardiovascular services: 75%, and
- For ophthalmology services: 80%.
The reduction applies to the following plans: Blue Advantage HMO, Blue Advantage Plus HMO, Blue Choice PPO, Blue Essentials, Blue Essentials Access, Blue Premier, Blue Premier Access, and ParPlan.
For a list of the services subject to the multiple procedure payment reduction, and examples of how it applies, visit the BCBSTX website.
The Texas Medical Association’s payment specialists continuously review health care payment plans’ newsletters and updates for items important to Texas physicians. Texas Medicine Today periodically publishes key excerpts from those newsletters that you might have missed.
If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Reimbursement Review and Resolution Service to help resolve insurance-related problems. Visit www.texmed.org/GetPaid for more resources and information.
Last Updated On
November 16, 2020