CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPOO7

Implant; Device, and Tissue Policy

Policy governs reimbursement and coding rules for medical implants, devices, and tissue supplies for Blue Cross Blue Shield of New Mexico members and applies to providers submitting claims to the Plan.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyImplant; Device, and Tissue Policy

Policy CodePolicy CPCPOO7

Change TypeNo material change

Effective DateJan 19, 2026

Next Review DateJan 19, 2026

Key ActionSubmit supporting documentation and, when billing revenue code 278, include a vendor invoice with matching units or the claim may be denied.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

30implant min duration (days)

278revenue code requiring invoice

not reimbursedautografts reimbursed separately

units must matchvendor invoice required

Reimbursement and Coverage Criteria

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.

ALL of the following

ALL of the following
- Autografts are not eligible for separate reimbursement; the cost for harvest and preparation is considered included in the procedure charge.
ALL of the following
- Materials and allografts that are dissolved/absorbed/resorbed/remodeled, and liquids (for example: sealants, hemostats, topical hemostats) will not be reimbursed if billed as an implant unless an exception applies (e.g., extended support of organs and tissues).
  conditional—exception possible
ALL of the following
- Providers will not be reimbursed for implants and supplies that are presumed contaminated, considered waste, or were not implanted in the member (examples: items prepared or opened but not implanted, items opened by mistake, surgeon change-of-mind, equipment failure/technical difficulties, surgery cancellation, large packages when smaller packaging is appropriate).
ALL of the following
- Allografts mixed with viable stem cells are considered experimental/investigational/unproven and are not eligible for reimbursement.
ALL of the following
- Provider or vendor administrative storage and delivery costs will not be reimbursed.
ALL of the following
- Many supplies, instruments, and miscellaneous items are not additionally reimbursed outside the global surgical fee; examples are listed in the policy.

ALL of the following

If billed as separately reimbursable under revenue code 278, the Plan may require a vendor invoice showing units; units on the vendor invoice must match units billed for revenue code 278 or the claim may be denied unless otherwise agreed upon.

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Coding and Revenue Code Requirements

Revenue code with invoice requirementRevenue

278	Revenue code referenced for implant billing requiring supporting vendor invoice

inv-03: Vendor invoice unit match — revenue code 278

RequirementUnits shown on the vendor's invoice must match the units billed for revenue code 278 or the revenue code 278 will be denied unless otherwise agreed upon

Vendor invoice must indicate unitsWhen implants were purchased in bulk, the invoice must specify the units that apply to the claim billed or revenue code 278 will be denied

Vendor invoice required when separately reimbursableIf implants are separately reimbursable, billed charges for revenue code 278 may require a vendor invoice to support the implants used corresponding to the services rendered

Consequence of mismatch or omissionIf the units do not match or are not noted on the vendor invoice, the revenue code 278 will be denied unless otherwise agreed upon

Provider Documentation & Plan Discretion

Documentation Required

Documentation request and vendor invoice requirement

Providers must submit accurate, complete supporting documentation when requested by the Plan. Claims are subject to review against benefit terms, provider contract language, medical policies, clinical payment and coding policies, and claim-edit logic. For revenue code 278 (implants/supplies) a vendor invoice may be required and that invoice must clearly indicate the units corresponding to the billed claim. If units are missing or do not match the billed units (including when implants are purchased in bulk), the revenue code 278 will be denied unless otherwise agreed upon by the Plan.

Revenue code 278: vendor invoice may be required
Invoice must clearly show units that match billed units
Bulk-purchased implants: invoice must note applicable units or claim may be denied
Providers should submit additional documentation upon request

Note

Plan interpretation and precedence

Blue Cross and Blue Shield of New Mexico reserves discretion to interpret and apply this policy to services delivered in individual cases. If there is a conflict between this Clinical Payment and Coding Policy and any member plan document, the plan document governs. If there is a conflict between this policy and a provider contract, the provider contract governs. Plan documents include, but are not limited to, Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents. BCBSNM has full and final discretionary authority for interpretation and application to the extent provided under applicable plan documents.

Plan documents govern over this policy when in conflict
Provider contracts govern over this policy when in conflict
BCBSNM may exercise reasonable discretion in interpreting and applying the policy

Key Definitions

inv-06: Implant — definition

DefinitionA medical implant is a device or tissue placed inside or on the surface of the body and intended to remain there for a period of 30 days or more (FDA definition)

Exceptions/shorter-durationDevices that remain in the body less than 30 days may still be considered implants in some cases (e.g., devices that deliver medication, monitor body functions, or provide organ/tissue support)

ExamplesMay include metal anchors, artificial joints, pins, plates, radioactive seeds, metal screws, shunts, stents, types of allografts and autografts

inv-07: Sealants / Hemostats / Adhesives — definitions

SealantsAgents that form a barrier to prevent leakage of fluids from tissues (e.g., cerebrospinal fluid or blood), preventing flow of liquids

Topical Hemostats / HemostatsMaterials that stop bleeding by causing blood to clot and require blood to be present to satisfy their clotting function

AdhesivesGlues capable of bonding various tissues together (including skin or muscle) and capable of bonding blood vessels

Reimbursement noteGenerally, liquids such as sealants, hemostats, and topical hemostats will not be reimbursed if billed as an implant unless an exception applies; autografts are not eligible for separate reimbursement