CurrentBlue Cross Blue Shield - New MexicoPolicy CPCP031

Trauma Activation - Facility Services

Defines trauma activation criteria, billing codes (revenue code 068x, HCPCS G0390, CPT 99291/99285), and reimbursement rules for designated trauma centers and hospitals; applies to providers billing Blue Cross Blue Shield New Mexico.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyTrauma Activation - Facility Services

Policy CodePolicy CPCP031

Change TypeNo material changes

Effective DateJul 14, 2023

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide supporting documentation upon request.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

068xRevenue code series

G0390, 99291Reportable HCPCS/CPT

30 minCritical care threshold

05Required FL14

6 criteriaHigh-level activation examples

Trauma Activation Coverage Criteria

Conditions and billing rules under which trauma activation charges may be submitted and reimbursed.

{

"operator":"all",

"label":"Coverage and facility requirements",

"children":[

{"text":"Trauma centers and hospitals must be licensed, designated, or authorized by the state and assigned a trauma level.","note":"Only designated trauma centers or hospitals may submit revenue code 068x."},

Designated trauma centers should not bill a trauma response activation level higher than their designated trauma center level.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyTrauma Activation - Facility Services

Policy CodePolicy CPCP031

Change TypeNo material changes

Effective DateJul 14, 2023

Next Review Date

Key ActionProviders must submit accurate documentation and may be asked to provide supporting documentation upon request.

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.

Example: a designated level II center cannot bill a level I trauma response even if level I was activated.

"label":"Minimal criteria for highest level trauma activation (must include one)",

{"text":"Confirmed systolic blood pressure < 90 mmHg in adults (age-specific hypotension in children)."},

{"text":"Respiratory compromise, obstruction, or intubation."},

{"text":"Use of blood products to maintain vital signs in patients transferred from other hospitals."},

{"text":"Discretion of the emergency physician."},

{"text":"Gunshot wounds to abdomen, neck, chest, or extremities proximal to the elbow or knee."},

Glasgow Coma Score < 9 with mechanism attributed to trauma.

"label":"Billing and coding rules for revenue code 068x",

{"text":"Revenue code 068x (0681, 0682, 0683, 0684, 0689) is used only for reporting trauma activation charges."},

{"text":"The revenue code billed is determined by the facility's ACS designation and the activation level (the revenue code submitted is determined by the activation level)."},

{"text":"Only designated trauma centers or hospitals may submit revenue code 068x; non-designated trauma centers should not use FL14 type 05 or 068x when billing for trauma services.","note":"If a member walks into the hospital or is driven without pre-arrival notification, 068x should not be billed; the member may be classified using FL 14 type 05 for follow-up purposes only."},

When billing revenue code 068x, use Form Locator (FL) 14, Type of Admission/Visit code 05 when a pre-arrival notification from a pre-hospital caregiver (e.g., EMS) occurred.

"label":"Concurrent billing with ED and critical care services",

{"text":"Emergency department level of care may be billed in addition to trauma activation services on the same claim; revenue codes 045x and 068x cannot be bundled but may appear on the same claim for the same date of service."},

{"text":"If at least 30 minutes of critical care is provided on the same date as a trauma activation, CPT 99291 (critical care) and HCPCS G0390 (trauma response team) may each be reported with one unit."},

Critical care services administered for less than 30 minutes when a trauma activation occurs may be billed using revenue code 068x, but HCPCS G0390 should not be billed.

"label":"Documentation and review",

{"text":"The plan reserves the right to request supporting documentation; claims may be reviewed on a case-by-case basis.","note":"Failure to adhere to coding and billing policies may impact claims processing and reimbursement."},

Examples of appropriate line-level billing per activation level are available (e.g., REV 0681 + G0390 and REV 0450 + 99291 for Level I).

Contact Network Management Office for additional information.

Billing Codes and Thresholds

Covered Revenue CodesRevenueCovered

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/local authorities)

Critical care duration threshold

Minimum billable duration for critical care30 minutes

Documentation and Claim Review Requirements

Documentation Required

Documentation and claim review — submit accurate documentation and provide supporting records upon request

Providers must submit accurate documentation of services performed and bill using valid HIPAA‑approved code combinations. Claims are subject to code-edit protocols and case‑by‑case review; upon request, providers should submit additional supporting documentation.

Submit claims coded according to industry-standard coding guidelines (UB, CPT, HCPCS, ICD-10, NDC, DRG, CMS/NCCI).
Be prepared to provide additional documentation when requested by the payer for claim review.

Key Definitions

Trauma activation team

DefinitionTrauma activation team = key staff members who receive the member's information from a pre-hospital caregiver prior to the member's arrival for triage

PurposeFacilitate prearrival communication so the facility can prepare appropriate triage and activation of resources

MembersIncludes essential clinical and support staff as defined by the facility's trauma activation policy (per ACS guidance)

ACS domains for activation

ACS activation domainsPhysiologic — patient vital signs and clinical status (e.g., hypotension, respiratory compromise)

AnatomicAnatomic injuries that meet criteria for highest-level activation (e.g., severe open fractures, penetrating injuries to torso/head/neck)

Mechanism of injuryHigh-risk mechanisms (e.g., high-speed MVC, falls from height, penetrating trauma) used to determine level of response