Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)
Defines services and procedure codes that Blue Cross Blue Shield of Texas will deny as non-reimbursable because they are considered experimental, investigational, or unproven; applies to claims submitted to BCBSTX except where plan documents or Texas Insurance Code require otherwise.
No material clinical or coverage changes in this revision.
Non-Reimbursable Criteria
Non-Reimbursable Criteria
Services and procedure codes specified on the Non-Reimbursable EIU Services Code List are not reimbursable.
List is maintained separately and posted under the policy; list includes CPT Category I, HCPCS, and CPT Category III codes designated as experimental, investigational, or unproven (EIU) and may not be all inclusive; codes on the list do not require clinical review to determine coverage and will be denied as non-reimbursable.
BCBSTX may use reasonable discretion interpreting and applying this policy to individual cases and must comply with applicable Texas Insurance Code; providers must submit accurate documentation upon request.
Codes and Clinical Review
| Refer to 'Non-Reimbursable EIU Services Code List' attachment for specific CPT, HCPCS, and CPT Category III codes denied as non-reimbursable |
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