CurrentBlue Cross Blue Shield - New MexicoPolicy CPCP018

Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes - Outpatient Facility Claims

Governs submission and billing requirements for outpatient facility claims to Blue Cross Blue Shield of New Mexico, requiring appropriate HCPCS/CPT or NDC codes paired with revenue codes; does not apply to inpatient claims and affects outpatient facility providers submitting claims.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyRevenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes - Outpatient Facility Claims

Policy CodePolicy CPCP018

Change TypeNo material change

Effective DateApr 14, 2025

Next Review Date

Key ActionEnsure outpatient facility claims include a supporting HCPCS, CPT or NDC code with the revenue code on the same line; if multiple procedure codes are needed, submit the revenue code on separate lines.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

outpatientsetting

procedure pairingrequirement

possibledenial risk

12x-89xbill types

NDC formatsformat guidance

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.

Outpatient Claim Submission Requirements

Outpatient claim submission criteria

Covered when ALL of the following are met:

This policy does not apply to inpatient claims (outpatient-only requirement).

Source: policy scope

Outpatient facility claims must include a supporting HCPCS, CPT, or NDC code paired with the revenue code when applicable.

Codes must reflect services provided on the date of service and be submitted for accurate processing

Revenue codes and corresponding procedure codes must be compatible.

Incompatible combinations may be subject to denial or edits

Procedure and revenue code pairing must be submitted on the same line; if more than one HCPCS, CPT or NDC is needed for a single revenue code, submit the revenue code on separate lines with each procedure code.

Ensures accurate claims processing

ALL of the following

Bill types at risk
- 12x
- 13x
- 14x
- 74x
- 75x
- 76x

Billing Codes, Bill Types, and NDC Formatting

Referenced bill types requiring procedure code pairingmixedCovered

12x	Bill Type
13x	Bill Type
14x	Bill Type
74x	Bill Type
75x	Bill Type
76x	Bill Type
83x	Bill Type
84x	Bill Type
85x	Bill Type
89x	Bill Type

inv-03: NDC formatting and transmission — ANSI 837I loop/qualifier guidance and paper CMS-1500/UB-04 field formatting notes

ANSI 837I electronic submissionUse Product ID Qualifier = N4 in LIN02 (Loop ID 2410); send the 11-digit NDC in the National Drug Code element (Loop 2410) and populate National Drug Unit Count in CTP04 with the quantity

NDC unit of measure (electronic)Populate Unit or Basis for Measurement (CTP05, Loop 2410) with the unit qualifier: UN, ML, GR, or F2

NDC unit count (electronic)Enter National Drug Unit Count (CTP04) as the number of NDC units administered

Field/segment IDs (electronic)Product ID Qualifier = LIN02; Product ID Qualifier Loop = 2410; National Drug Code segment = National Drug (Loop 2410)

Submission Actions and Denial Risk

Denial Risk

Include procedure/NDC with revenue code on same line — denial risk if omitted

All outpatient facility claims must include the supporting HCPCS, CPT, or NDC code on the same line as the revenue code; if more than one procedure/drug code is required for a revenue code, submit the revenue code on separate lines. Failure to submit a compatible procedure code with a revenue code may result in denial for the listed bill types (12x, 13x, 14x, 74x, 75x, 76x, 83x, 84x, 85x, 89x).

Include HCPCS, CPT, or NDC on the same line as the revenue code for accurate claims processing.
If multiple procedure/NDC codes are needed for one revenue code, reproduce the revenue code on separate lines with each procedure/NDC.
Denial risk applies when a revenue code is submitted without appropriate procedure code(s) for bill types 12x, 13x, 14x, 74x, 75x, 76x, 83x, 84x, 85x, and 89x.

Key Definitions and Technical Notes

inv-05: Revenue code pairing requirement — definition that revenue code must be submitted with an appropriate HCPCS, CPT, or NDC for outpatient (inpatient excluded)

Outpatient-only scopeThis requirement applies to outpatient facility claims; inpatient claims are excluded

Revenue code pairing ruleA revenue code on an outpatient facility claim must be submitted with an appropriate HCPCS, CPT, or NDC code

Line-item submissionRevenue codes and corresponding procedure/drug codes should be submitted on the same line; if multiple procedure codes are needed for one revenue code, submit the revenue code on separate lines

Denial riskThe plan may deny outpatient facility claims when a revenue code is submitted without appropriate procedure code(s) for specified bill types

inv-06: Technical formatting instructions for NDC on electronic and paper claim forms including qualifiers, loop/field IDs, and unit/quantity formats