Reimbursement Policy Updates

REQUIREMENTS: - By July 24, 2026: Billing team must obtain and review RP016 (Chiropractic Care Services) and RP043 (Lactation Support Services) policies in full. Update billing rules and encounter templates as needed. Communicate changes to providers. - By August 14, 2026: Billing team must obtain and review RP031 (Trauma Activation - Facility Services) and RP035 (Unlisted/NOC Coding Policy). Update trauma activation billing protocols and NOC code guidance in billing system. - By August 21, 2026: Billing team must obtain and review RP021 (Laboratory Panel Billing) policy. Update laboratory panel billing rules to reflect new stacking, bundling, or frequency limitations if applicable. - By November 16, 2026: Billing team must obtain and review RP052 (Robotic Assisted Surgery). Update billing system to reflect any new CPT codes, modifiers, or reimbursement methodology for robotic procedures. - By December 4, 2026: Billing team must obtain and review all 11 laboratory-specific policies (RPLAB004, RPLAB014, RPLAB032, RPLAB045, RPLAB046, RPLAB049, RPLAB050, RPLAB056, RPLAB057, RPLAB061, RPLAB063, RPLAB071). Update laboratory testing billing rules, prior authorization requirements, and frequency limitations in billing system. Identify which tests require prior auth, have quantity limits, or are subject to medical necessity edits. - ACTION: Obtain full policy text for each policy ID from BCBS Texas provider portal to extract specific CPT/HCPCS codes, billing rules, and documentation requirements. This policy notice is a summary only and does not contain specific code-level guidance needed for accurate billing. - CONSEQUENCE: Without full policy review and system updates, claims may be denied or delayed due to incorrect coding, missing prior authorization, or billing rule violations.