CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Not Separately Reimbursed / Non‑Reimbursed Code List

Describes codes that BCBSRI considers covered but not separately reimbursable (packaged into other services) or codes for which alternate codes should be used; affects professional and institutional providers contracting with Blue Cross & Blue Shield of Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyNot Separately Reimbursed / Non‑Reimbursed Code List

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJun 1, 2013

Next Review DateN/A

Key ActionVerify member benefits/eligibility via the Benefit Booklet, Evidence of Coverage or Subscriber Agreement and contact the Provider Call Center for member-specific benefits.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

updated quarterlyfrequency of list updates

Jan 1, 2025code status effective

NSRprimary coverage stance

multiplepublication history

Coverage stance and scope

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

Covered when the following statements apply:

Codes listed are covered but may be included in the allowance of another service and therefore not separately reimbursed.

Reimbursement and coverage may vary by product, group, and contract; refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable benefits.

Codes with CMS OPPS Addendum B status indicator 'N' and certain other codes are treated as covered but not separately reimbursed (packaged into other services) in claims processing.

Some codes may be NSR (Not Separately Reimbursed) only for specific ages or provider types; see the attached code list or contact Customer Service for code-specific details.

Call Customer Service for code-specific coverage information; the attached list is updated quarterly and reflects code status as of January 1, 2025.

Code list and coding status

Attached Non‑Reimbursed / Alternate Code Listmixed

Codes listed in the attached Excel workbook indicating professional and institutional code status as of January 1, 2025; includes 'Not Separately Reimbursed' and 'Use Alternate Code' designations.

CMS OPPS Addendum B status N — Packaged (treated as covered but not separately reimbursed)

CMS OPPS Addendum B statusStatus indicator 'N' codes are treated as covered but not separately reimbursed (payment packaged into other services).

Claims processing setupCodes with Addendum B status 'N' are configured as covered and not separately reimbursed in BCBSRI claims systems.

Billing to memberServices designated NSR are not billable to the member.

Scope variationsSome codes may be NSR only for certain ages or provider types; specific details are in the attached list or via Customer Service.

What providers must do

Prior Authorization

Prior Authorization — Not applicable

Prior authorization is not required for services described in this policy.

Documentation Required

Verify Benefits — Confirm member-specific coverage

Verify member benefits and eligibility using the member's Benefit Booklet, Evidence of Coverage or Subscriber Agreement; for member-specific benefit questions, contact the Provider Call Center.

Benefits and eligibility are determined by the member’s subscriber agreement, member certificate, and/or employer agreement; those documents supersede this policy.
For member-specific benefits or questions, call the Provider Call Center.

Terminology used in this policy

NSR — Not Separately Reimbursed

DefinitionNot Separately Reimbursed (NSR) is used when a code is covered but not a separately reimbursable service; payment is packaged into other services.

Member billingNSR services are not billable to the member.

Provider/age exceptionsSome codes may be NSR only for certain ages or provider types; see the attached list for specifics.

Reference guidanceBCBSRI generally follows CMS OPPS guidance for NSR determination and claims setup.

Use Alternate Code — Reporting equivalent CPT/HCPCS

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

Reporting requirementWhen 'Use Alternate Code' is indicated, providers must report the equivalent CPT or HCPCS code rather than the listed code.

Source listDetails and the specific alternate code mapping are provided in the attached workbook or code list.