CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Not Separately Reimbursed / Use Alternate Code listing

This document governs BCBSRI's designation of specific CPT/HCPCS codes as covered but not separately reimbursed (NSR) or to be reported using alternate codes; it applies to professional and institutional providers and may vary by product and contract.

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 Date

Key ActionCall Customer Service for specific information on coverage and provider-specific questions.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

updated quarterlyfrequency of list updates

professional & institutionalprovider types covered

CMS OPPS Nbasis for many NSR determinations

Category II excludedcodes not intended for reimbursement

Coverage Determinations

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 stance

BCBSRI designates the codes listed in this policy as covered but not separately reimbursed (NSR) or requires reporting using alternate codes; reimbursement and billing requirements may vary by product, contract, age, or provider type.

BCBSRI has determined that the codes listed in this policy are covered services but providers will not be separately reimbursed for the services; many of the services are included in the allowance of another service or BCBSRI will not reimburse them separately even if the listed service is the only service filed.

Reimbursement may vary by product and by group or contract; benefits and coverage should be confirmed in the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement.

BCBSRI generally follows CMS OPPS (Addendum B) for many NSR determinations; codes with a status indicator of "N" are typically set up in claims processing as covered but not separately reimbursed because payment is packaged into other services.

Not Separately Reimbursed (NSR) indicates a code is covered but not separately reimbursable and these services are not billable to the member; some codes may be NSR only for specific ages or provider types.

For codes that require reporting using an alternate code, providers should report the equivalent CPT or HCPCS code for the service rendered as specified; refer to the attached code listing for specifics.

This list is updated quarterly. For specifics about coverage, alternate coding, or provider-specific questions, contact BCBSRI Customer Service.

Code Listings and Status

Not Separately Reimbursed and Use Alternate Codemixed

No codes listed

CMS OPPS status indicator — "N" meaning

CMS OPPS status indicatorCodes with an OPPS status indicator of "N" are typically set up in BCBSRI claims processing as covered but not separately reimbursed (payment packaged into other services).

Reference sourceBCBSRI generally refers to the CMS Hospital Outpatient OPPS Fee Schedule (Addendum B) when determining NSR status.

Impact on billingServices designated with OPPS status "N" are not separately reimbursable to the provider and are not billable to the member.

Actions Providers Must Take

Prior Authorization

Prior authorization: Not applicable

Prior authorization is not required for services listed in this document.

Note

Contact Customer Service for coverage and provider questions

Call Customer Service for specific information on coverage, member-specific benefits, and provider-specific questions; the list is updated quarterly.

For member-specific benefits and eligibility, call the provider call center as referenced in the policy.
The Non Reimbursed / Use Alternate Code list is updated quarterly; contact Customer Service to confirm current coverage and reporting guidance.

Key Terms

NSR — Not Separately Reimbursed (definition and implications)

DefinitionNot Separately Reimbursed (NSR) indicates a code is covered but not separately reimbursable; payment is considered packaged into payment for other services.

Billing consequenceNSR services are not billable to the member and generally will not generate separate reimbursement on a claim.

Basis for determinationBCBSRI generally follows CMS OPPS designations (status indicator "N") and may also include additional codes determined internally.

Scope limitsSome codes may be NSR only for specific ages or provider types as noted by BCBSRI.

Use Alternate Code — reporting guidance

DefinitionUse Alternate Code indicates there is an equivalent CPT or HCPCS code that should be reported for the service actually rendered.

Reporting requirementWhen this designation applies, providers must report the alternate (equivalent) CPT/HCPCS code rather than the listed code.

PurposeEnsures accurate coding and claims processing by aligning reported codes with services rendered using an accepted equivalent code.