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Five New Claims Editing Rules will be Implemented November 2025
BCBS Texas·TX · Emergency Medicine, Radiology, General Surgery·General
Effective date
Nov 16, 2025
We identified it
Jan 12, 2026
Summary
Blue Cross Blue Shield of Texas will implement five new claims editing rules on November 16, 2025, affecting coding and reimbursement for emergency room surgical services, STI testing, radiation therapy, trauma activation, and professional/technical components. Claims receiving secondary edits will show ineligible reason codes with 'L' alpha character.
Action Required
By November 16, 2025: Billing team must update claim submission processes to include Modifier 54 for ER surgical services without follow-up care, bundle STI test codes (87491, 87591, 87661) to comprehensive code 87801 when multiple tests are performed same day, ensure radiation therapy planning code 77301 is properly linked with intensity modulated therapy codes, verify trauma activation claims include critical care code 99291 with revenue code 068X and G0390, and avoid billing technical component codes on professional claims in facility settings. Use Clear Claim Connection tool to test coding combinations before submission.