Trauma Activation - Facility Services
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Defines when trauma activation is recognized and how the Plan reimburses facility trauma activation, critical care, and related ED services for members; applies to facilities and designated trauma centers billing Blue Cross Blue Shield of Texas.
Trauma Activation Coverage Criteria
Trauma activation billing and coverage criteria
Billing and coverage rules for trauma activation and related services — covered when documentation supports designated trauma center activation and applicable clinical criteria.
Minimal criteria (any ONE of the following) for highest-level trauma activation must be met
- Confirmed systolic blood pressure <90 mm Hg in adults (age-specific hypotension in children).
- Respiratory compromise, airway obstruction, or intubation.
- Use of blood products to maintain vital signs in patients transferred from other hospitals.
- Discretion of the emergency physician.
- Gunshot wounds to abdomen, neck, chest, or extremities proximal to the elbow or knee.
- Glasgow Coma Score less than 9 with mechanism attributed to trauma.
Billing Codes and Thresholds
| 0681-0684,0689 | Revenue codes O68X for trauma response levels; 0681-0684 map to trauma response levels I-IV; 0689 for other/assigned levels |
| G0390 | HCPCS - trauma response team (reportable with one unit when ≥30 minutes of critical care provided same date) |
| 99291 | CPT - critical care physician services (reportable with one unit when ≥30 minutes and trauma activation occurs same date) |
| FL14 Visit Code 05 | Type of Admission/Visit code to identify pre-arrival notified trauma admissions; non-designated centers should not use FL14 type 5 or O68X |
Documentation and Notification Requirements
Documentation, pre-arrival notification, and Plan contact
The Plan may request supporting documentation for trauma activation and related billing; contact the Plan for additional information. If pre-arrival notification from a pre-hospital caregiver (e.g., EMS) occurred, FL 14 Type of Admission/Visit code 05 may be used and revenue code O68X billed by a designated trauma center only. Non-designated centers must not use FL 14 Type 05 or O68X.
- Plan reserves the right to request supporting documentation and may withhold or adjust reimbursement for noncompliant claims.
- Only designated, state-licensed/authorized trauma centers may bill revenue code family O68X.
- Use FL 14 Type of Admission/Visit code 05 only when a pre-arrival notification from a pre-hospital caregiver was received; non-designated centers should not use FL14 Type 05 or O68X.
Key Definitions
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