Outpatient Facility Revenue Code Billing Requirements
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Defines reporting requirements for CPT/HCPCS and modifiers on outpatient facility claims submitted to Blue Cross Blue Shield - Maine; applies to facilities billing outpatient services to this payer unless overridden by provider, state, or federal contracts or requirements.
Added revenue codes to the Related Coding section to require HCPCS or CPT codes when submitted for reimbursement.
Updated Related Coding section by adding revenue code 0300.
Added clarifying language for additional revenue codes.
Outpatient Facility Billing Requirements
Outpatient facility billing criteria
Billing requirements for outpatient facility claims to be reimbursed by the health plan:
ALL of the following
- Examples include revenue codes: 0270 (Medical/Surgical Supplies and Devices), 0271 (General Medical/Surgical Supplies and Devices), 0272 (Nonsterile Medical/Surgical Supplies and Devices), 0920 (Other Diagnostic Services), and 0940 (Other Therapeutic Services).
Revenue Codes and Related Coding Rules
| 0270 | Medical/Surgical Supplies and Devices - requires corresponding HCPCS/CPT |
| 0271 | General Medical/Surgical Supplies and Devices - requires corresponding HCPCS/CPT |
| 0272 | Nonsterile Medical/Surgical Supplies and Devices - requires corresponding HCPCS/CPT |
| 0920 | Other Diagnostic Services - requires corresponding HCPCS/CPT |
| 0940 | Other Therapeutic Services - requires corresponding HCPCS/CPT |
Billing and Authorization Expectations for Facilities
Report CPT/HCPCS with revenue codes and bill applicable modifiers
Facilities must report current and valid CPT or HCPCS codes with all revenue codes on outpatient facility claims and must bill applicable modifiers. Follow state, federal, or provider contract requirements and ensure services meet authorization and medical necessity guidelines; failure to follow coding/billing guidelines or reimbursement policies may result in claim denial, rejection, or recoupment.
- Report current and valid CPT or HCPCS codes for revenue codes identified with a 'Y' indicator by the NUBC and for revenue codes listed in the Related Coding section.
- Bill applicable modifiers on outpatient facility claims.
- Follow authorization and medical necessity requirements and applicable provider, state, or federal contracts; improper coding/billing may lead to claim denial, rejection, or recovery of payment.
Key Terms
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