CurrentBlue Cross Blue Shield - IllinoisPolicy CPCPO31

Trauma Activation- Facility Services

Defines when trauma activation billing is appropriate for designated trauma centers, revenue codes and related billing/coding guidance, and how critical care and ED services may be reported in conjunction with trauma activation. Affects facilities (hospitals/designated trauma centers) submitting claims to Blue Cross Blue Shield of Illinois.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyTrauma Activation- Facility Services

Policy CodePolicy CPCPO31

Change TypeNo material changes

Effective DateJan 6, 2026

Next Review Date

Key ActionSubmit supporting documentation upon request and ensure accurate claim coding when billing trauma activation and associated services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

O68XRevenue code family used for trauma activation

30 minMinimum critical care time

Designated centersWho may submit O68X

FL14 VC05Required visit code with 068X

G0390 + 99291Codes reportable together (≥30 min)

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When Trauma Activation Billing Is Appropriate

Trauma activation billing and reporting criteria

When trauma activation billing is appropriate and how to report associated services:

ALL of the following

Facility must have received pre-arrival notification from a pre-hospital caregiver (e.g., EMS) to bill revenue code O68X and FL 14 Type of Admission/Visit code 05; if the patient walks in or is driven without notification, O68X should not be billed (the member may still be classified as trauma for follow-up using FL 14 Type 05).
Cite NUBC guidance for pre-arrival requirement.

ALL of the following

Only designated trauma centers or hospitals may submit revenue code O68X; non-designated centers must not use FL 14 Type 05 or O68X when billing for trauma services.
Revenue code O68X restricted to designated centers per ACS/state designation guidance.

ALL of the following

The specific revenue code within O68X (0681-0684, 0689) is determined by the activation level and should not exceed the facility’s designated trauma level (e.g., a Level II center may not bill a Level I activation).
Select revenue code consistent with facility ACS designation and activation level.

Highest level activation minimal criteria

Confirmed systolic blood pressure <90 mm Hg in adults (age-specific hypotension for children).
Respiratory compromise, obstruction, or intubation.
Use of blood products to maintain vital signs in patients transferred from other hospitals.
Discretion of the emergency physician.
Gunshot wounds to abdomen, neck, chest, or extremities proximal to the elbow or knee.
Glasgow Coma Scale <9 with mechanism attributed to trauma.

ALL of the following

If trauma activation occurs and the facility administers at least 30 minutes of critical care on the same date of service, CPT 99291 (critical care) and HCPCS G0390 (trauma response team) may each be reported with one unit.
If critical care administered is less than 30 minutes when trauma activation occurs, the facility may report charges under revenue code(s) O68X but should not report HCPCS G0390.

ALL of the following

Emergency department level(s) of care may be billed in addition to trauma activation on the same claim; revenue codes 045X (ED) and O68X are not bundled and may appear together when appropriate.

Revenue, CPT and HCPCS Codes for Trauma Activation

Trauma activation and associated codesmixedCovered

O68X (0681-0684,0689)	Revenue codes for trauma response levels (0681-0684, 0689 other trauma response).
G0390	HCPCS — Trauma response team (one unit when billing with ≥30 minutes critical care).
99291	CPT — Critical care physician services (reportable with trauma activation when ≥30 minutes).
045X	Emergency department revenue codes — may be billed in addition to trauma activation on same claim (not bundled with 068X).

Critical care time threshold — CPT 99291 + G0390 with trauma activation

Minimum critical care time30 minutes — CPT 99291 and HCPCS G0390 may each be reported with one unit when the facility delivers at least 30 minutes of critical care on the same date as a trauma activation.

If <30 minutesIf critical care <30 minutes, the facility may report revenue code O68X charges but should not report HCPCS G0390.

Units allowedTrauma activation is considered a one-time occurrence and may only be billed with one unit in association with critical care services on the same date.

Codes referencedCPT 99291 (critical care physician services) and HCPCS G0390 (trauma response team) — may be reported together only when the 30‑minute threshold is met.

Claim reportingWhen threshold met, report 99291 and G0390 each with one unit on the same date of service alongside appropriate O68X revenue code(s).

Documentation and Policy Governance Responsibilities

Documentation Required

Documentation Requests and Provider Responsibility

Providers are responsible for submission of accurate documentation of services performed. The Plan may request supporting documentation and providers are urged to submit any additional records upon request to substantiate billed services. Claims are subject to code edit protocols and claim review, which may include review of benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic. Failure to adhere to coding and billing policies, or to provide requested documentation, may impact claims processing and reimbursement.

Submit claims using valid code combinations from HIPAA-approved code sets (CPT, HCPCS, ICD-10, NDC, etc.).
Code claims according to industry standard coding guidelines (Uniform Billing Editor, AMA CPT guidance, CMS NCCI edits, DRG rules, CMS manuals, etc.).
Provide requested supporting documentation promptly when the Plan requests it.
Contact the Plan for questions about trauma activation or trauma-related procedure billing.

Note

Policy Governance

Key Definitions

Trauma activation — institutional response and billing triggers

DefinitionAn institutional response level determined by physiologic, anatomic, mechanism and other factors per American College of Surgeons guidance used to mobilize resources for incoming trauma patients.

Pre-arrival notification requirementRevenue code(s) O68X should be used with FL 14 type of admission/visit code 05 only when the facility received pre-arrival notification from a pre-hospital caregiver (e.g., EMS). If the patient arrives without notification, O68X should not be billed.

Use with FL 14 Visit Code 05Per NUBC guidance, O68X is billed in conjunction with FL 14, Type of Admission/Visit code 05 to indicate trauma activation when pre-arrival notification occurred.

Non-designated centersNon-designated trauma centers must not use FL 14 type 5 or revenue code O68X when billing for trauma services.

Designated trauma center — submission of revenue code O68X