Observation Services
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This policy governs payment for medically necessary observation services, including duration limits, exclusions for services incidental to inpatient stays or other outpatient services, and charge limits. It applies to providers billing Blue Cross Blue Shield of Vermont.
The coding table was updated to replace deleted observation and inpatient-service codes with codes 99221-99223, 99238, and 99239 for eligible payment and codes 99231-99233 for services not eligible for payment.
The window before separately billing services rendered before inpatient admission was changed from 48 hours to 72 hours for alignment between discount-off-charge and DRG payment arrangements.
Language defining total time was added.
The policy was moved to a new template and underwent language and grammatical edits for clarification.
The policy name changed from "Observation Services and Other Services Incidental to Inpatient Admission" to "Observation Services."
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