CurrentBlue Cross Blue Shield - IllinoisPolicy CPCP007

Implant, Device, and Tissue Policy

Defines reimbursement, coding, and documentation expectations for implants, devices, grafts, sealants, hemostats, and related supplies for Blue Cross Blue Shield of Illinois members and participating providers.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyImplant, Device, and Tissue Policy

Policy CodePolicy CPCP007

Change TypeNo material change

Effective DateJan 19, 2026

Next Review Date

Key ActionSubmit supporting documentation and vendor invoices when billing revenue code 278 and ensure units match the claim to avoid denial.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

30 daysFDA time threshold

278Revenue code

Not reimbursedContaminated/unused

Examples listedSeparate supplies

Oct. 13, 2025Approval

Implant, Device, and Tissue Reimbursement Criteria

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Implant/device/tissue reimbursement criteria

Summary of reimbursement determinations and billing rules:

Autografts are not eligible for separate reimbursement; harvest and preparation costs are included in the procedure charge.

Materials, allografts that are dissolved/absorbed/resorbed/remodeled, and liquids (such as sealants, hemostats, and topical hemostats) generally will not be reimbursed as implants unless an exception applies (for example, extended support of organs and tissues).

A supply or instrument that is intended to be removed or discarded during the same inpatient or outpatient procedure or single episode of care is not considered an implant and is not separately reimbursable.

Providers will not be reimbursed for implants and supplies that are presumed contaminated, wasted, or were not implanted (including items prepared or opened but not used, opened by mistake, surgeon change-of-mind, equipment failure, case cancellation, or inappropriate bulk packaging).

If items are separately reimbursable under Revenue Code 278, the claim may require a vendor invoice with units clearly indicated and matching the billed units; mismatched or missing units may result in denial unless otherwise agreed upon.

Provider or vendor administrative storage and delivery costs will not be reimbursed; items and services should be encompassed under the surgical rate and not billed to the member unless permitted by the member’s benefit plan.

Exclusion: Allografts mixed with viable stem cells are considered experimental/investigational/unproven and are not eligible for reimbursement.

Supply examples: Examples of supplies and products that will not be additionally reimbursed outside the global fee include (but are not limited to) Surgiflo, Evicel, Floseal, Tisseel, Seprafilm and related instruments/miscellaneous items as listed in policy.

Governance: If a conflict exists between this policy and a plan document or provider contract, the applicable plan document or contract governs; BCBSIL may apply reasonable discretion in policy application.

Revenue Codes, Duration Thresholds, and Coding Notes

Revenue codes and invoice rulesRevenue

278	Other Implants (Revenue Code 278) - if separately reimbursable, billed charges may require a vendor's invoice with units clearly indicated; mismatched or missing units may result in denial.

Implant duration threshold

FDA implant duration thresholdAn implant is intended to remain in the body for a period of 30 days or more (FDA definition).

Exceptions to 30-day ruleDevices that remain <30 days may still be considered implants if they deliver medication, monitor body functions, or provide support to organs/tissues.

Typical examples listedMay include metal anchors, artificial joints, pins, plates, radioactive seeds, metal screws, shunts, stents, and certain allografts and autografts.

Documentation, Invoicing, and Claims Accuracy

Documentation Required

Documentation and Invoice Requirements

Providers must submit accurate, complete documentation and valid coding for services rendered. Claims should use HIPAA-approved code sets and follow industry coding guidelines (eg, Uniform Billing Editor, AMA CPT, HCPCS, ICD-10-CM/PCS, NDC, DRG rules, CMS NCCI edits). Claims are subject to code-edit protocols and claim review against benefit terms, provider contract language, medical policies, CPCPs, and coding software logic. Upon request, providers should furnish additional documentation to support the claim.

Use HIPAA-approved code sets and industry coding guidance (CPT, HCPCS, ICD-10, NDC, DRG, NCCI)
Submit supporting documentation upon request for claim review
Claims reviewed against benefit coverage, provider contracts, medical and coding policies

Billing Rule

Invoice and Vendor Documentation

The Plan may request supporting documentation or vendor invoice detail (for example, Revenue Code 278 or other vendor invoices) to substantiate billed implant or supply charges. Failure to provide requested documentation or invoices may result in claim adjustment or denial. Providers are responsible for maintaining and submitting invoices, charge tickets, implant logs, and any vendor-supplied paperwork that verifies device identity, quantity, and cost when requested.

Plan may request vendor invoices (eg, Revenue Code 278) or other supporting documentation
Retain and provide implant logs, charge tickets, and vendor paperwork to verify device identity, quantity, and cost
Failure to provide documentation may result in claim adjustment or denial

Denial Risk

Claims Accuracy and Waste — Reimbursement Exclusions

Implants and supplies that are contaminated, unused, or wasted are not reimbursable. Providers and facilities are expected to manage implants and supplies to minimize waste. Examples of non-reimbursable situations include items prepared or opened but not implanted, items opened by mistake, changes in surgeon choice, equipment failure, case cancellation, and use of oversized packaging when smaller packaging is appropriate. Autografts are not separately reimbursable; their harvesting/preparation costs are considered included in the procedure charge. Supplies or instruments intended to be removed or discarded during the same procedure or episode of care are not considered implants for separate reimbursement.

No reimbursement for contaminated, unused, or wasted implants/supplies (prepared/opened but not used; opened by mistake; surgeon change-of-mind; equipment failure; case cancellation)
Autograft harvest/preparation costs included in procedure charge — not separately reimbursed
Supplies/instruments removed or discarded during the same procedure are not implants and not separately reimbursed

Key Definitions

Implant — definition

Core definitionAn implant is a device or tissue placed inside or on the surface of the body, intended to remain for 30 days or more.

Short-term implant exceptionsA device that remains in the body less than 30 days may still be considered an implant if it delivers medication, monitors body functions, or provides support to organs/tissues.

Example device typesIncludes metal anchors, artificial joints, pins, plates, radioactive seeds, metal screws, shunts, stents, and certain allografts and autografts.

Adhesives

Adhesives definitionGlues capable of bonding various tissues together, including surfaces such as skin or muscle, and capable of bonding blood vessels.

Use case implicationIntended to approximate and secure tissue surfaces where sutures or staples may be used.

Tissue typesCan bond multiple tissue types (skin, muscle, blood vessels).

Hemostats

Hemostats definitionMaterials effective for diffusing bleeding.

FunctionUsed to control or reduce bleeding at surgical sites by promoting hemostasis.

FormulationsMay be topical absorbable hemostats or topical thrombins (examples referenced elsewhere in policy).

Material

Material definitionInorganic or biological substance(s) that cannot be dissolved, absorbed, resorbed, or remodeled.

Implication for reimbursementMaterials meeting this definition are treated as nonresorbable and considered in implant/material determinations.

ContrastDistinct from materials or liquids that are dissolved, absorbed, resorbed, or remodeled, which may not be reimbursed as implants.

Sealants

Sealants definitionAgents that can prevent the leakage of potentially nonclotting fluids from tissues (e.g., cerebrospinal fluid) and form a barrier preventing liquid flow.

Additional capabilityMay also be capable of preventing leakage of blood from blood vessels.

Primary purposeUsed to create a fluid-tight barrier at surgical sites or tissue defects.

Topical Hemostats

Topical hemostats definitionMaterials that stop bleeding by causing blood to clot and thus require blood to be present to satisfy their clotting function.

MechanismPromote clot formation at the site of bleeding; function dependent on presence of blood.

Typical applicationApplied directly to bleeding tissue surfaces during surgical procedures to achieve hemostasis.