CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Not Separately Reimbursed (NSR) codes / Non-reimbursed code list

This policy describes codes that BCBSRI considers covered but not separately reimbursable (included in other service allowances or not payable) and applies to professional and institutional providers across BCBSRI products; benefits may vary by contract.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyNot Separately Reimbursed (NSR) codes / Non-reimbursed code list

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 6, 2013

Next Review DateJul 1, 2024

Key ActionPrior authorization not applicable.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

quarterlylist update frequency

Jan 1, 2024code status effective

NSRprimary stance

variesreimbursement varies

Not Separately Reimbursed — Coverage Criteria

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.

Codes listed as Not Separately Reimbursed (NSR) are covered but not separately reimbursable; payment is included in the allowance of another service and these services are not billable to the member.

Entries marked 'Use Alternate Code' require reporting the equivalent CPT or HCPCS code in place of the listed code.

Reimbursement and applicability may vary by product, group contract, age, and provider type; refer to the member's Benefit Booklet/Evidence of Coverage or Subscriber Agreement or call Customer Service for specifics.

BCBSRI generally refers to CMS OPPS Addendum B status indicators (for example, status indicator 'N') when configuring claims processing for many NSR codes; those codes are set up as covered but not separately reimbursed because CMS considers payment packaged into other services.

The attached workbook reflects code status for professional and institutional providers as of January 1, 2024 and is updated quarterly; the list is not all-inclusive and may be changed to add or delete codes.

Key Definitions

Not Separately Reimbursed (NSR)

DefinitionNot Separately Reimbursed (NSR): a code that is covered but not separately reimbursable because payment is packaged into another service; these services are not billable to the member.

CMS alignmentBCBSRI generally refers to CMS OPPS (Addendum B) status indicators (e.g., 'N') when determining NSR treatment.

ApplicabilitySome codes may be NSR only for specific ages or provider types; reimbursement may vary by product, group contract, and provider type.

Claims processingCodes with an OPPS 'N' status are typically configured in claims processing as covered but not separately reimbursed (payment packaged into other services).

Use Alternate Code

DefinitionUse Alternate Code: indicates an equivalent CPT or HCPCS code exists and that equivalent code should be reported for the service rendered.

When to useApplies when the listed code has an equivalent CPT/HCPCS code — report the equivalent code instead of the listed code.

PurposeEnsures the service is captured and billed using the appropriate, reportable CPT/HCPCS code for claims and data collection.