CurrentBlue Cross Blue Shield - IllinoisPolicy CPCP031

Trauma Activation - Facility Services

Defines when trauma activation is considered to have occurred and how Blue Cross Blue Shield of Illinois reimburses and expects billing for trauma activation, critical care, and related emergency department facility services for designated trauma centers.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyTrauma Activation - Facility Services

Policy CodePolicy CPCP031

Change TypeClarified — grammatical/formatting and references updated

Effective DateJan. 6, 2026

Next Review Date

Key ActionSubmit accurate documentation and provide supporting documentation to the Plan upon request for trauma activation or trauma-related billing.

SourceLink

POLICY UPDATE CHANGES

Grammatical and formatting updates; References updated.

068Xrevenue code family used for trauma activation

G0390HCPCS code for trauma response team

99291CPT critical care code

FL14=05FL14 visit code when pre-arrival exists

30mminimum critical care duration

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Trauma Activation Coverage Criteria

Trauma activation coverage criteria

Covered when the following conditions and billing rules are met:

Trauma activation coverage and billing adhere to the following rules and conditions.

Minimal criteria for highest level activation — must include ONE of the following

Confirmed systolic blood pressure of <90 mm Hg in adults and age-specific hypotension in 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 Score less than 9 with mechanism attributed to trauma.

Designated center billing

Only designated trauma centers or hospitals may submit revenue code 068X; the specific 068X code billed is determined by the facility's ACS designation and the activation level.

Pre-arrival notification requirement

Revenue code(s) 068X should be used with FL14 Type of Admission/Visit code 05 only when the facility received pre-arrival notification from a pre-hospital caregiver (e.g., EMS).
If the member self-presents (driven or walks in) without pre-arrival notification, revenue code(s) 068X should not be billed; FL14 Type 05 may still be used to classify the visit for follow-up purposes.
Non-designated trauma centers should not use FL14 Type 05 or revenue code(s) 068X when billing for trauma services.

Critical care concurrent billing

If a trauma activation occurs and the designated facility administers at least 30 minutes of critical care on the same date of service, report one unit each of CPT 99291 and HCPCS G0390 (trauma response team).
Trauma activation is a one-time occurrence per day and only one unit of HCPCS G0390 may be billed per day.
If critical care administered by the hospital is less than 30 minutes when a trauma activation occurs, report the trauma activation charge under revenue code(s) 068X but do not report HCPCS G0390.

ED services and trauma activation on same claim

Emergency department level of care may be billed in addition to trauma activation services on the same claim and same date of service.
Revenue codes 045X and 068X are not bundleable; both may appear on a single claim with the appropriate ED level codes and trauma activation revenue code(s).

Designation-level billing constraint

Designated trauma centers must not bill a trauma response activation level higher than their designated center level (e.g., a Level II center should not bill a Level I activation).

Revenue, HCPCS, and CPT Codes

Revenue codes for trauma response levels (068X)RevenueCovered

0681	Trauma Response Level I
0682	Trauma Response Level II
0683	Trauma Response Level III
0684	Trauma Response Level IV
0689	Other Trauma Response (assigned by state or local authorities)

HCPCS/CPT codes referenced for trauma and ED critical care billingmixedCovered

G0390	Trauma response team (HCPCS) — one unit when ≥30 minutes of critical care on same date
99291	Critical care services, first 30–74 minutes (CPT) — one unit when ≥30 minutes of critical care on same date
99285	ED visit, high severity (example for very short lived activations where time-based critical care not applicable)

Critical care minimum duration — billing rules for CPT 99291 and G0390

Minimum duration to report CPT 99291 and HCPCS G0390At least 30 minutes of critical care provided on the same date of service

Units allowed per day for trauma activation codesOne unit each of CPT 99291 and HCPCS G0390 may be reported — trauma activation is a one-time occurrence per day

When critical care <30 minutesIf critical care is less than 30 minutes, facility may bill revenue code 068X but should NOT report HCPCS G0390

ApplicabilityApplies when a trauma activation occurs under a 068X response level at a designated hospital or facility

Documentation, Billing Restrictions, and Provider Responsibilities

Documentation Required

Submit accurate documentation and provide supporting records on Plan request

Providers must submit accurate documentation of services performed and are expected to code claims using valid HIPAA-approved code sets and industry-standard coding guidelines. Upon Plan request, providers should submit any additional supporting documentation; contact the Plan for additional information on trauma activation or trauma-related billing.

Submit accurate documentation of services performed and use valid HIPAA-approved code sets (CPT, HCPCS, ICD-10-CM/PCS, etc.).
Claims are subject to code edits and review; upon Plan request, provide additional supporting documentation.
Contact the Plan for additional information on trauma activation or trauma-related procedure billing.

Billing Rule

Key Definitions and Codes

Trauma activation domains (Physiologic, Anatomic, Mechanism, and other factors)

Physiologic, Anatomic, Mechanism of injuryThree primary domains used to determine trauma activation levels per ACS guidance

Other factors consideredAge, anticoagulation or bleeding disorders, burns, end-stage renal disease requiring dialysis, pregnancy >20 weeks, time-sensitive extremity injury, CPR, blunt or penetrating trauma, trauma registry data, and regional considerations

Use for facility activation policyACS domain criteria are applied when creating a hospital activation policy as described in the Optimal Resources guide

Type of Admission/Visit code indicating trauma when pre-arrival notification received

FL14 Type of Admission/Visit code for trauma with pre-arrival notificationFL14 = Type 05 must be used in conjunction with revenue code 068X when facility received pre-arrival notification from a pre-hospital caregiver