This policy defines the criteria and billing rules applicable to facility trauma activations billed to Blue Cross Blue Shield of Oklahoma. It aligns with the American College of Surgeons (ACS) guidance on trauma system resources and activation domains (Physiologic, Anatomic, Mechanism of injury) and incorporates National Uniform Billing Committee (NUBC) directions for use of revenue code 068x with Form Locator 14, Type of Admission/Visit code 05 when prearrival notification has occurred. The policy clarifies that trauma activation teams are key staff notified by a pre-hospital caregiver prior to the member’s arrival and that facilities must exercise independent medical judgment in providing care.
The policy includes a concise set of minimal criteria for the highest level of trauma activation, including: systolic blood pressure <90 mmHg in adults (age-specific hypotension in children); respiratory compromise, obstruction, or intubation; use of blood products to maintain vital signs in transferred patients; emergency physician discretion; gunshot wounds to the abdomen, neck, chest, or extremities proximal to the elbow or knee; and Glasgow Coma Score <9 with mechanism attributed to trauma.
Billing rules require that only state-licensed, designated, or authorized trauma centers may submit revenue code 0681–0684 or 0689, that the revenue code billed must match the facility’s ACS/state designation (a Level II center may not bill Level I activation), and that revenue code 068x is used solely to report trauma activation charges. Per NUBC guidance, 068x should be billed with FL 14 Type 05 only when prearrival notification from EMS or another pre-hospital caregiver occurred; if the patient self-presents or walks in without notification, do not bill 068x (the patient may still be identified with FL 14 Type 05 for follow-up).
When trauma activation and critical care occur on the same date of service, if the facility provides at least 30 minutes of critical care, one unit each of CPT 99291 (critical care) and HCPCS G0390 (trauma response team) may be reported. If critical care is administered for less than 30 minutes during a trauma activation, bill the trauma activation revenue code 068x but do not bill HCPCS G0390. Emergency department revenue codes (045X) may be billed in addition to trauma activation (068X) on the same claim; these revenue codes are not bundled.
Policy history shows the policy was originally issued 05/08/2020 with annual reviews and non-material verbiage/examples updates through the most recent committee approval on 07/11/2023 and plan effective date of 07/12/2023. Providers should retain supporting documentation and be prepared to submit records upon request. For additional trauma activation or trauma-related billing questions, contact your Network Management Office.