CurrentAnthemPolicy C-24003

Trauma Activation - Facility

Defines Anthem's reimbursement criteria for facility trauma activation charges on UB-04 claims for commercial lines, including required codes and minimum critical care time, affecting outpatient facility billing and reimbursement.

Policy Summary

PayerAnthem

PolicyTrauma Activation - Facility

Policy CodePolicy C-24003

Change TypeNo material change

Effective DateApr 1, 2026

Next Review DateN/A

Key ActionSubmit trauma activation on a UB04 with revenue code 068X and include CPT 99291 on the same claim; minimum 30 minutes of critical care is required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

068Xrequired revenue code

99291required CPT on claim

30 minminimum critical care

99292additional 30-min code

G0390HCPCS trauma team

Coverage Criteria

Trauma activation reimbursement criteria

Conditions required for reimbursement of trauma activation on facility (UB-04) claims:

ALL of the following

Claim must be submitted on a UB04 with revenue code 068X
CPT 99291 must be billed on the same claim
Minimum critical care duration of 30 minutes must be met for CPT 99291
Trauma activation submitted without CPT 99291 on the same claim will not be reimbursed
CPT 99292 (each additional 30 minutes) is non-reimbursable

Policy Summary

PayerAnthem

PolicyTrauma Activation - Facility

Policy CodePolicy C-24003

Change TypeNo material change

Effective DateApr 1, 2026

Next Review DateN/A

Key ActionSubmit trauma activation on a UB04 with revenue code 068X and include CPT 99291 on the same claim; minimum 30 minutes of critical care is required.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coding

Trauma activation revenue/HCPCS/CPT codesmixedCovered

0681	Level 1 Trauma (must be billed with 99291)
0682	Level 2 Trauma (must be billed with 99291)
0683	Level 3 Trauma (must be billed with 99291)
0684	Level 4 Trauma (must be billed with 99291)
0689	Other Trauma Response (must be billed with 99291)
G0390	Trauma response team associated with hospital critical care service (reimbursable)
99291	Critical care, evaluation, and management of the critically ill or critically injured patient; first 30-74 minutes (reimbursable)
99292	Critical care, evaluation, and management of the critically ill or critically injured patient; each additional 30 minutes (non-reimbursable)

Minimum Critical Care Duration

Minimum critical care duration30 minutes

Applies to CPT 9929199291 requires minimum 30 minutes (first 30-74 minutes)

Additional critical care time99292 (each additional 30 minutes) is non-reimbursable

Provider Actions & Billing Requirements

Billing Rule

Billing: UB‑04 revenue code 068X with CPT 99291 required

Submit trauma activation facility charges on a UB-04 claim with revenue code 068X (e.g., 0681, 0682, 0683, 0684, 0689) and include CPT 99291 on the same claim. Ensure CPT 99291 represents a minimum critical care duration of 30 minutes; CPT 99292 is non-reimbursable. Follow any applicable provider, state, or federal mandates that may supersede this policy.

Use revenue code 068X on the UB-04 (examples: 0681–0684, 0689) and bill with CPT 99291 on the same claim.
CPT 99291 requires a minimum critical care duration of 30 minutes to support reimbursement.
CPT 99292 (each additional 30 minutes) is non-reimbursable.
Policy guidance may be superseded by provider, state, or federal contracts/mandates.

Definitions

Trauma Activation — Definition & Criteria

DefinitionDeployment of medical professionals, or a trauma team, to coordinate care for a patient with traumatic injury based on predefined criteria (e.g., vital sign abnormalities, neurological dysfunction, mechanism of injury).

Required claim form and revenue codeTrauma activation must be billed on a UB04 with revenue code 068X (e.g., 0681, 0682, 0683, 0684, 0689)

Supporting critical care codeCPT 99291 must be billed on the same claim to be considered for reimbursement

HCPCS trauma response codeG0390 is reimbursable when associated with hospital critical care service

Non-reimbursable submissionTrauma activation submitted without CPT 99291 on the same claim will not be reimbursed