CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Emergency Room Reimbursement

Defines which services are included in or excluded from the facility emergency room (ER) per-visit payment rate for participating providers and notes variations by hospital contract and applicable copayments.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyEmergency Room Reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateFeb 15, 2011

Next Review DateN/A

Key ActionPrior authorization is not required for services covered by this policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

99281-99288, 99291-99292listed CPT ranges for ED and critical care services

MRA/MRI separately reimbursedexplicit exclusion from ER visit rate

Professional services paid separatelyfacility rate excludes professional services

Facility Emergency Room Reimbursement — What the Rate Includes / Excludes

ER facility reimbursement criteria

Stance on what is included in or excluded from the facility ER visit rate and how the ER facility rate interacts with observation admissions, professional services, surgical procedures, and contract-specific reimbursements:

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

Durable medical equipment (e.g., bandages, crutches, canes, collars, other supplies) is included in the ER visit per-visit rate.
Laboratory services are included in the ER visit per-visit rate.
Medications provided during the ER visit are included in the ER visit per-visit rate.
CT scans performed during the ER visit are included in the ER visit per-visit rate.
Radiology services performed during the ER visit are included in the ER visit per-visit rate.

ALL of the following

MRA/MRI are separately reimbursed and excluded from the ER visit rate.

ALL of the following

If a member is seen in the Emergency Room and is later admitted to observation status, both the Emergency Room and Observation rates are reimbursed (see Observation Services payment policy).

ALL of the following

Professional services are billed and reimbursed separately and are not included in the facility ER rate.

ALL of the following

If the surgical procedure is performed in the Operating Room, the surgical case facility rate is paid in addition to the Emergency Room facility payment rate.
If the surgical procedure is performed in the Emergency Room, no separate facility surgical case reimbursement is paid; only the ER facility rate is paid.

ALL of the following

All other services are contract specific; reimbursement may vary between hospital contracts and applicable copayments will be applied.

Key Terms and Payment Definitions

ER visit payment rate — definition

DefinitionEmergency room (ER) visit payment rate: a per‑visit facility reimbursement that covers services provided during an ER visit (see policy overview).

IncludesFacility items and services provided during the ER visit (for example: durable medical equipment, laboratory, medications, CT and radiology as listed in policy statement).

Contract variabilityReimbursement may vary between hospital contracts and applicable copayments will be applied.

Professional services

Billing relationshipProfessional services are billed and reimbursed separately from the facility ER visit rate.

Facility rate exclusionProfessional (physician) services are not included in the facility per‑visit ER rate.

Implication for claimsProviders should submit professional service charges separately from facility ER claims to receive separate reimbursement.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyEmergency Room Reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateFeb 15, 2011

Next Review DateN/A

Key ActionPrior authorization is not required for services covered by this policy.

SourceLink

On This Page

OpenPayer

Emergency Room Reimbursement

Facility Emergency Room Reimbursement — What the Rate Includes / Excludes

ED and Critical Care Codes

Provider Authorization & Billing Requirements

Key Terms and Payment Definitions

99281-99288	Emergency Department Services
99291-99292	Critical Care Services