Non-Reimbursable Experimental/Investigational/Unproven Services (EIU)
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Defines services, procedure codes and code categories that Blue Cross Blue Shield of Illinois considers experimental, investigational or unproven and not reimbursable when billed; applies to providers submitting claims to BCBSIL for covered members.
No material clinical or coverage changes in this revision.
Non-Reimbursable EIU Services — Coverage Criteria
Non-Reimbursable EIU Services
Services and codes designated as experimental, investigational or unproven (EIU) are not reimbursable and do not require clinical review; see the external code list for specific codes.
Codes and Code List Applicability
| See attachment | Codes in the separate 'Non-Reimbursable EIU Services Code List' (CPT Category I, CPT Category III, HCPCS) that are denied as non-reimbursable |
Provider Documentation, Claims and Denial Risk
Documentation and review
No clinical review is required for services designated as Experimental/Investigational/Unproven (EIU). Providers must submit accurate documentation of services performed and may be asked to provide additional documentation upon request.
- Submit claims using valid, industry-standard code sets and guidelines (e.g., CPT, HCPCS, ICD-10).
- Be prepared to respond to requests for additional documentation to support claims.
Denial risk for listed codes
Items listed on the Non‑Reimbursable EIU Services Code List are denied as non‑reimbursable when submitted on a claim based on the member's plan documents.
- Refer to the 'Non‑Reimbursable EIU Services Code List' posted under this policy for specific CPT (including Category III) and HCPCS codes.
- The code list is not all‑inclusive; denials apply per the member's plan documents and policy description.
Key Definitions
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