CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Not Separately Reimbursed (NSR) and Use Alternate CPT/HCPCS Codes

Defines codes that BCBSRI considers covered but not separately reimbursable (NSR) and indicates when alternate CPT/HCPCS codes should be used; applies to providers submitting professional and institutional claims to Blue Cross and Blue Shield of Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyNot Separately Reimbursed (NSR) and Use Alternate CPT/HCPCS Codes

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 6, 2013

Next Review DateAug 8, 2025

Key ActionDo not separately bill services designated as Not Separately Reimbursed (NSR); they are packaged into payment for other services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

01/01/2025code-status master list effective

quarterlyupdate frequency

NSRprimary stance

professional & institutionalprovider types

General Coverage and Reimbursement Rules

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.

General Coverage and Reimbursement Rules

The attached excel workbook contains the definitive code status for professional and institutional providers; reimbursement and benefits may vary by product, group, and contract.

The attached excel workbook reflects the code status for professional and institutional providers as of January 1, 2025 (see attached workbook).

Reimbursement for codes listed in the workbook may vary by product; benefits may vary between groups and contracts. Refer to the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for member-specific coverage.

The Non‑Reimbursed / Use Alternate Code list is updated quarterly; providers should contact Customer Service for specific coverage information.

Codes designated as Not Separately Reimbursed (NSR) are packaged into payment for other services and are not billable to the member; when an equivalent CPT or HCPCS code exists, the 'Use Alternate Code' indication specifies the alternative code that should be reported.

Code Status: NSR and Alternate CPT/HCPCS Guidance

NSR (Not Separately Reimbursed) Codesmixed

No codes listed

Use Alternate Codemixed

No codes listed

CMS OPPS status‑N influence

OPPS status indicator 'N' meaningCodes with OPPS status indicator 'N' on CMS Addendum B are typically set up as covered but not separately reimbursed by BCBSRI (payment is considered packaged into other services)

Claims processing impactWhen a code is designated 'N' it is configured in claims processing as covered but not separately reimbursed (not billed separately to the member)

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

ExceptionsSome codes may be NSR only for specific ages or provider types; consult the code master list and member benefits

Provider Billing and Authorization Actions

Prior Authorization

Prior authorization: Not applicable

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

Billing Rule

Not Separately Reimbursed (NSR) — do not bill separately

Do not bill separately for codes designated Not Separately Reimbursed (NSR); these services are packaged into payment for other services and are not billable to the member.

BCBSRI follows CMS OPPS conventions: codes with status indicator 'N' on Addendum B are typically set up as covered but not separately reimbursed.
Some codes may be NSR only for specific ages or provider types; refer to the attached code list and member benefit documents for details.

Key Definitions

Not Separately Reimbursed (NSR) — definition

DefinitionA code that is covered but not separately reimbursable because payment is packaged into other services; these services are not billable to the member.

Billing ruleProviders should not separately bill for services designated as Not Separately Reimbursed (NSR); payment is considered included with other services.

Relationship to CMS guidanceBCBSRI often follows CMS OPPS conventions when determining NSR status and uses Addendum B status indicators as a reference.

VariabilityNSR designation may vary by age, provider type, product, or group/contract; verify with the attached code workbook and member benefit documents.

Use Alternate Code — definition

DefinitionIndication used when an equivalent CPT or HCPCS code exists and that alternative code should be reported for the rendered service.

When to useApply the 'Use Alternate Code' indicator when the code list shows an equivalent CPT/HCPCS code that more accurately describes the performed service.

Reporting requirementReport the specified alternate CPT or HCPCS code for the service rendered per the code master list and guidance.