CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Not Separately Reimbursed / Use Alternate Code services list

This policy lists procedure and service codes that BCBSRI considers covered but not separately reimbursable (NSR) or that should be billed using an alternate equivalent code; it affects professional and institutional providers submitting claims to Blue Cross & Blue Shield of Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyNot Separately Reimbursed / Use Alternate Code services list

Policy CodePolicy N/A

Change TypeNo material change

Effective Date06/01/2013

Next Review DateN/A

Key ActionPrior authorization: Not applicable; for coverage specifics call Customer Service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

updated quarterlyfrequency of list updates

as of 2025-01-01code status workbook date

through Jul 2025publication history

Coverage and Reimbursement Stance

Coverage stance

Coverage and reimbursement stance for codes listed in the attached workbook:

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Blue Cross and Blue Shield of RI (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 has determined that even if the service listed is the only service filed, we will not reimburse it separately; reimbursement may vary by product and between professional and institutional providers.

The attached Excel workbook reflects the code status for professional and institutional providers as of January 1, 2025; the list is updated quarterly.

Not Separately Reimbursed (NSR)

Codes with a CMS OPPS Addendum B status indicator of 'N' are generally set up in BCBSRI claims processing as covered but not separately reimbursed because CMS considers the payment packaged into payment for other services.
There are additional codes BCBSRI may consider not separately reimbursed; NSR means the code is covered but not a separately reimbursable service and is not billable to the member.
Some codes may be NSR only for specific ages or provider types; benefits and reimbursement may vary by group/contract—refer to the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement.

Not Separately Reimbursed / Use Alternate Code

Not Separately Reimbursed / Use Alternate Code listmixedCovered

Excel workbook attached to policy lists codes that are covered but not separately reimbursed (NSR) or for which an alternate CPT/HCPCS should be used.

CMS OPPS status indicator 'N'

DefinitionCodes with status indicator 'N' on CMS Addendum B are generally set up as covered but not separately reimbursed in BCBSRI claims processing; CMS considers payment packaged into other services.

Implication for billingServices designated NSR are covered but not separately reimbursable and are not billable to the member.

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

ExceptionsSome codes may be NSR only for specific ages or provider types; refer to the attached workbook for code-level detail.

Prior Authorization and Contact

Prior Authorization

Prior authorization / Customer Service

Prior authorization is not applicable for the services on this list. For coverage specifics, providers should call Customer Service; the Non Reimbursed/Use Alternate Code list is updated quarterly.

Prior authorization: Not applicable.
List updated quarterly; call Customer Service for specific coverage information.

Key Terms

NSR — Not Separately Reimbursed

TermNot Separately Reimbursed (NSR)

MeaningNSR indicates a code is covered but not a separately reimbursable service because payment is considered packaged into payment for other services.

Billing effectNSR services are not billable to the member; providers should not expect separate reimbursement for these codes.

ScopeNSR determinations are included in the policy's attached workbook; check the workbook for code-, age-, and provider-specific NSR designations.

Use Alternate Code — reporting guidance

TermUse Alternate Code

MeaningIndicates an equivalent CPT or HCPCS code should be reported for the service rendered.

Action for providersReport the equivalent CPT/HCPCS code specified in the attached workbook when this indication applies.

ReferenceSee the policy's attached Excel workbook for the specific alternate code to report for each listed service.