Implant; Device, and Tissue Policy
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Defines reimbursement, coding, and documentation rules for implants, devices, grafts, sealants, hemostats and related supplies for Blue Cross Blue Shield of Illinois members and providers submitting claims under the plan.
No material clinical or coverage changes in this revision.
Reimbursement Criteria and Exclusions
Reimbursement criteria and exclusions
Rules on what is separately reimbursable and common exclusions:
Billing and Coding Requirements for Implants and Supplies
| Revenue code 278 | Other implants — may require vendor invoice and unit detail to support separate reimbursement |
Documentation, Invoicing, and Denial Risk Guidance
Submit supporting documentation and vendor invoices (Revenue Code 278 may require vendor invoice)
The Plan may request supporting documentation and vendor invoices to substantiate implants billed (for example, when billing Revenue Code 278). Providers must submit accurate documentation and claims using valid code sets and include vendor invoices with clear unit detail that correspond to the services rendered.
- Submit vendor invoice showing units that match the claim when billing Revenue Code 278.
- Provide any additional documentation upon request to support the implant charges.
- Ensure claims are coded using valid HIPAA-approved code sets and industry standard coding guidelines.
No reimbursement for contaminated, unused, or wasted implants/supplies
Providers will not be reimbursed for implants and supplies that are presumed contaminated, considered waste, or were not implanted in the member; avoidable waste may impact payment. The Plan urges providers and facilities to utilize implants and supplies efficiently to prevent waste.
- Examples of non-reimbursable waste: items opened/prepared but not used, items opened by mistake, surgeon change-of-mind, equipment failure/technical difficulties, surgery case cancellation, and bulk packages when inappropriate units are billed.
- Do not bill for contaminated, unused, or wasted implants/supplies as these will be denied.
Key Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.