CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Not Separately Reimbursed (NSR) and Alternate Code List

Defines codes that BCBSRI considers covered but not separately reimbursable or that require reporting with an alternate code; applies to professional and institutional providers and varies by product and contract.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyNot Separately Reimbursed (NSR) and Alternate Code List

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 6, 2013

Next Review DateJan 1, 2025

Key ActionReport services using an equivalent CPT or HCPCS code when an alternate code is indicated; services listed as NSR are not separately billable to the member.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

updated quarterlyfrequency of list updates

Medicare Advantage & Commercialproducts referenced

effective 06/01/2013policy timeline

excludedCategory II treatment

Coverage Stance and Not Separately Reimbursed Codes

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 for listed codes

Codes listed are generally covered but are not separately reimbursed, or require use of an alternate code; coverage and reimbursement depend on product and contract.

Codes on the BCBSRI list are covered but not separately reimbursed (Not Separately Reimbursed - NSR); payment is typically packaged into the allowance for another service and these services are not billable to the member.

Codes with a CMS OPPS status indicator 'N' are generally set up in BCBSRI claims processing as covered but not separately reimbursed (packaged) because CMS treats payment as packaged into related services.

When an equivalent/alternate CPT or HCPCS code is identified, report the service using that alternate code as indicated by the list (Use Alternate Code).

Reimbursement and code status may vary by product (e.g., Medicare Advantage vs Commercial), by provider type, and by contract; consult the attached workbook, the member's benefit booklet, Evidence of Coverage, or Subscriber Agreement for specifics.

Category II CPT/HCPCS performance-measurement codes (e.g., codes in the XXXXF/GXXXX/MXXXX series) are used for performance measurement and data collection and are not intended for reimbursement; they are excluded from separate payment consideration.

Code Lists and Reimbursement Notes

Category II / Performance Measurement CodesCPT | HCPCSNot Covered

Category II (XXXXF,GXXXX,MXXXX)

Performance measurement codes not intended for reimbursement

CMS OPPS 'N' status packaged codesmixedNot Covered

OPPS Status N codes

Codes with status indicator 'N' on CMS OPPS are generally covered but not separately reimbursed (packaged).

Reimbursement variance

ApplicabilityReimbursement may vary by product (e.g., Medicare Advantage vs Commercial).

Source of specificsConsult the attached workbook for code status for professional and institutional providers as of January 1, 2025.

Provider/contract variationBenefits and reimbursement can differ by provider type, group, and contract; refer to benefit booklets or subscriber agreements for details.

Provider Billing and Reporting Actions

Prior Authorization

Prior Authorization — Not Applicable

Prior authorization is not required for the codes in this policy.

Denial Risk

Not Separately Reimbursed (NSR) — Billing Risk

These codes are covered but are not separately reimbursable (Not Separately Reimbursed — NSR); the services are not billable to the member and payment may be packaged into other services.

Provider liability: reimbursement may vary by provider type (professional vs institutional).
Some codes may be NSR only for specific ages or provider types.

Billing Rule

Use Alternate Code — Report Using Equivalent CPT/HCPCS

When the list indicates an alternate code, report the service using the equivalent CPT or HCPCS code specified.

Use the alternate CPT/HCPCS code for reporting when an equivalent code exists per the policy list.

Definitions

Not Separately Reimbursed (NSR)

Definition'Not Separately Reimbursed' (NSR) indicates a code is covered but is not a separately reimbursable service.

Billing impactServices designated NSR are not billable to the member.

Conditional NSRSome codes may be NSR only for specific ages or provider types; verify applicability on the code list.

Use Alternate Code

When to useReport the service using an equivalent CPT or HCPCS code when an alternate code indication is provided.

PurposeUse Alternate Code indicates the submitted code should be replaced with the equivalent code for accurate reporting and claims processing.

Source guidanceFollow the policy list/workbook to identify the appropriate alternate CPT or HCPCS code for the service rendered.

Category II Codes

PurposeCategory II CPT and HCPCS codes are used for performance measurement and data collection about quality of care.

Reimbursement statusCategory II codes are not intended for reimbursement and are excluded from the BCBSRI list for payment purposes.

Code format examplesExamples include codes in the XXXXF, GXXXX and MXXXX series used for performance metrics.