CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Not Separately Reimbursed / Use Alternate Code listing

Governs which professional and institutional CPT/HCPCS codes are considered covered but not separately reimbursed (or require alternate codes) for Blue Cross & Blue Shield of Rhode Island providers; affects billing and reimbursement practices across products and contracts.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyNot Separately Reimbursed / Use Alternate Code listing

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 1, 2013

Next Review DateN/A

Key ActionRefer to the attached workbook and member benefit materials; prior authorization is not applicable and this policy does not guarantee payment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Jan 1, 2025code status effective

Quarterlyupdate frequency

Not applicableprior authorization

Not applicablemedical criteria

Provider Updatespublished communications

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.

Coverage Guidance

Coverage guidance

BCBSRI considers the listed codes covered but generally not separately reimbursed; reimbursement may be packaged into other services or vary by product, contract, age, or provider type. Refer to the attached workbook and the member's benefit booklet or subscriber agreement for applicability.

Codes listed in the attached workbook are considered covered services by BCBSRI but are generally not separately reimbursed.

ALL of the following

Reimbursement may be packaged into the allowance of another service or otherwise not paid separately even if the code is the only service filed.
Reimbursement practices may vary by product, contract, group, age, or provider type; refer to the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for member-specific coverage.

ALL of the following

Codes with a CMS OPPS Addendum B status indicator of 'N' are typically set up in BCBSRI claims processing as covered but not separately reimbursed (payment packaged into other services).
BCBSRI also designates additional codes as Not Separately Reimbursed (NSR) in the attached system listing; NSR indicates the code is covered but not separately reimbursable and is not billable to the member.

Not Separately Reimbursed / Use Alternate Code

Not Separately Reimbursed / Use Alternate Codemixed

Attached Excel workbook lists codes that are covered but not separately reimbursed (NSR) or require alternate CPT/HCPCS codes; Category II codes excluded.

CMS OPPS status indicator N handling

BCBSRI handling of CMS OPPS Status Indicator 'N'Codes with CMS OPPS status indicator 'N' (per Addendum B) are configured in BCBSRI claims processing as covered but not separately reimbursed — payment is considered packaged into other services.

Source guidanceBCBSRI generally refers to the CMS Hospital Outpatient Prospective Payment System (OPPS) fee schedule when determining NSR status for codes.

Implication for billingServices designated 'N' are not separately reimbursable to the member and typically cannot be billed separately; reimbursement is included in another service's payment.

Scope notesSome codes may be NSR only for specific ages or provider types; refer to the attached workbook for code-level details and applicability.

Prior Authorization and Payment Notices

Prior Authorization

Prior Authorization / Payment Notice

Prior authorization: Not applicable. Check member benefits and eligibility prior to providing services. Benefits, eligibility, and payment are governed by the member's subscriber agreement, member certificate, and any employer or participation agreements; those documents supersede this policy. This medical policy is informational and is not a guarantee of payment or a substitute for clinical judgment. If services are determined to be not medically necessary or are non-covered benefits, do not bill the member unless the member has been informed and has agreed in advance to pay. BCBSRI may review and revise this policy at any time; contact the provider call center for member-specific benefit information.

Prior authorization: Not applicable
Verify member benefits and eligibility before rendering services
Benefits and payment governed by subscriber agreement, member certificate, and employer/participation agreements
Do not charge members for non-covered or not-medically-necessary services unless member has given advance agreement to self-pay
This policy is informational and not a guarantee of payment; BCBSRI may revise the policy at any time

Key Definitions

Not Separately Reimbursed (NSR)

DefinitionNot Separately Reimbursed (NSR) is used when a code is covered but not a separately reimbursable service; payment is packaged into other services and these services are not billable to the member.

PurposeNSR codes are often used for performance measurement and data collection and are not intended for separate reimbursement.

ApplicabilitySome codes may be NSR only for certain ages or provider types; check the attached workbook and benefit documents for applicability by product/contract.

ExclusionsCategory II codes are excluded from the NSR/Use Alternate Code listing as noted in the policy materials.

Use Alternate Code

Definition