CurrentBlue Cross Blue Shield - MainePolicy G-26001

Reimbursement Policy Treatment Rooms

Governs reporting of CPT/HCPCS codes and reimbursement rules for treatment room revenue codes 0760, 0761, and 0769 on outpatient facility claims for Blue Cross Blue Shield - Maine provider network.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyReimbursement Policy Treatment Rooms

Policy CodePolicy G-26001

Change TypeNo material change

Effective Date07/01/2026

Next Review Date

Key ActionReport CPT or HCPCS codes when billing revenue codes 0760, 0761, or 0769 on outpatient facility claims; failure to follow guidelines may result in claim denial or payment adjustment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3treatment room revenue codes covered

6mutually exclusive revenue groups

07/01/2026effective

02/17/2026last review

Treatment Room Reporting and Reimbursement Criteria

Treatment room billing and reimbursement criteria

Reporting and reimbursement rules

Providers must report CPT or HCPCS codes when billing revenue codes 0760, 0761, or 0769 on outpatient facility claims unless overridden by provider, state, or federal contracts/mandates.

Do not reimburse when any of the following are present

New or established evaluation and management (E/M) services reported with revenue code 0760, 0761, or 0769.
HCPCS code G0463 (hospital clinic services) reported with revenue code 0760, 0761, or 0769.
Revenue codes 0760, 0761, or 0769 billed on the same claim with any of the following revenue code groups: Emergency room (045X), Outpatient surgery (036X), Recovery room (071X), Observation (0762), Clinic (051X), or Freestanding clinic (052X).

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyReimbursement Policy Treatment Rooms

Policy CodePolicy G-26001

Change TypeNo material change

Effective Date07/01/2026

Next Review Date

Key ActionReport CPT or HCPCS codes when billing revenue codes 0760, 0761, or 0769 on outpatient facility claims; failure to follow guidelines may result in claim denial or payment adjustment.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Revenue and Procedure Codes

Covered Treatment Room Revenue CodesRevenueCovered

0760	Treatment room revenue code
0761	Treatment room revenue code
0769	Treatment room revenue code

Not reimbursed when reported with treatment room revenue codesHCPCSNot Covered

G0463

Hospital outpatient clinic visit (HCPCS)

Revenue code groups mutually exclusive with treatment room revenue codesRevenueNot Covered

045X	Emergency room revenue codes
036X	Outpatient surgery revenue codes
071X	Recovery room revenue codes
0762	Observation revenue code
051X	Clinic revenue codes
052X	Freestanding clinic revenue codes

Not reimbursed E/M servicesCPTNot Covered

New or established E/M

New or established evaluation and management (E/M) services when reported along with revenue codes 0760, 0761, or 0769

Standard correct coding

Standard correct codingApply standard correct coding practices when reporting CPT or HCPCS for treatment room revenue codes (0760, 0761, 0769).

Use of CPT/HCPCSReport the appropriate CPT or HCPCS code that accurately describes the service provided in the treatment room.

Code specificityEnsure code selection reflects the full clinical documentation and meets national coding conventions.

Follow coding guidelinesAdhere to CPT, HCPCS, and payer-specific coding rules to avoid claim denials or adjustments.

Authorization, Claims Compliance, and Provider Responsibilities

Prior Authorization

Meet authorization, documentation, and claims requirements to avoid denials

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis and to the member's state of residence. Use proper billing and submission guidelines, including industry-standard CPT, HCPCS, and revenue codes; billed codes must be fully supported in the medical record and/or office notes. Failure to follow coding/billing guidelines or current reimbursement policies may result in claim rejection, denial, recovery/recoupment of payment, or reimbursement adjustment.

Obtain any required authorizations and verify medical necessity per member state rules before providing or billing services.
Submit claims using correct CPT, HCPCS, and revenue codes and ensure documentation in the medical record fully supports billed codes.
Noncompliance with coding/billing guidelines can lead to claim rejection, denial, recovery, or payment adjustment.

OpenPayer

Reimbursement Policy Treatment Rooms

Treatment Room Reporting and Reimbursement Criteria

Revenue and Procedure Codes

Authorization, Claims Compliance, and Provider Responsibilities

General Reimbursement Policy Definitions