Revision 24-2; Effective Sept. 20, 2024

3410 Billing Procedures

Revision 24-2; Effective Sept. 20, 2024

Grantees must accept fee-for-service (FFS) payment rates for screening, diagnostic and patient navigation services specified in Med-IT®.

BCCS client data must be entered in Med-IT® no later than 45 days after each service was provided. BCCS services and procedures that have been met will be marked approved to pay and submitted electronically to HHSC for processing through the state comptroller. Paid claims will be deposited into the grantee’s direct deposit account. Grantees may be reimbursed only for services listed in the BCCS Billing Guideline.

Completed MBCC applications must not be submitted to HHSC until all client data and patient navigation billing have been entered in Med-IT®.

The BCCS Billing Guideline is in Appendix VI. 

3420 Funding for Screening Mammograms and MRI

Revision 22-0; Effective August 15, 2022

Reimbursement for screening mammograms and MRI for high-risk asymptomatic women 40 – 49 must initially be billed using the B codes listed in the BCCS Billing Guideline.

Note: BCCS funds may not be used for breast cancer screening in clients under 40.

3430 Funds for Cervical Dysplasia (CD) Management and Treatment

Revision 24-2; Effective Sept. 20, 2024

Federal funds may never be applied to treatment services. Non-federal funds should be used for CD management and treatment services for women who meet BCCS eligibility criteria and have a definitive, biopsy confirmed diagnosis of:

  • CIN I, CIN II and CIN II-III; or
  • CIN III or CIS if the client does not meet eligibility criteria for Medicaid for Breast and Cervical Cancer (MBCC). CIN III and CIS results should always be screened for MBCC eligibility before CD treatment enrollment.