CurrentBlue Cross Blue Shield - TexasPolicy CPCPO31

Trauma Activation- Facility Services

Defines when trauma activation is recognized and how designated trauma centers and hospitals should bill and be reimbursed for trauma activation, critical care, and related emergency department services; applies to providers submitting claims to Blue Cross and Blue Shield of Texas.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyTrauma Activation- Facility Services

Policy CodePolicy CPCPO31

Change TypeNo material changes

Effective DateAug 1, 2024

Next Review Date

Key ActionUse revenue code 068x only for designated trauma centers after pre-arrival notification and use FL 14 Visit Code 05 when pre-arrival notification occurred.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

068xRevenue code series reserved for trauma activation

30 minMinimum critical care time

FL14:05Admission/Visit code for pre-arrival

Designated centers068x submission allowed by

Multi-tieredResponse structure

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.

Trauma activation coverage criteria

Trauma activation billing and coverage criteria

Conditions under which the plan allows billing for trauma activation and associated services:

Facility must be a state-licensed and designated trauma center to bill revenue code 068x.

The revenue code submitted (0681, 0682, 0683, 0684, 0689) is determined by the activation level and must not exceed the facility's designated trauma center level.

Pre-arrival notification from a pre-hospital caregiver (e.g., EMS) is required to bill revenue code 068x and to use FL 14 Type of Admission/Visit code 05; if the member self-presents or walks in without notification, 068x should not be billed (the member may still be designated via FL 14 for follow-up).

Billing for critical care and trauma team activation

If at least 30 minutes of critical care are administered on the same date of service during a trauma activation, report CPT 99291 (first 30-74 minutes) and HCPCS G0390 (trauma response team) each with one unit.
If critical care is provided for less than 30 minutes during a trauma activation, the facility may report a charge under revenue code 068x but should not report HCPCS G0390.

Emergency department level of care (appropriate ED E/M level or other non–time-based ED code) may be billed in addition to trauma activation services on the same claim; revenue codes 045X and 068x are not bundled and may appear together on the same claim.

If a member expires shortly after arrival, report the appropriate non–time-based ED code (for example CPT 99285) together with the applicable 068x and ED revenue code as illustrated in plan examples.

The plan may request supporting documentation and claims are subject to review and coding edits; failure to adhere to these billing rules may impact claims processing and reimbursement.

Allowed trauma, ED, and critical care codes

Allowed trauma and ED codesmixedCovered

068x	Revenue codes for trauma response levels (0681, 0682, 0683, 0684, 0689)
G0390	Hospital outpatient prospective payment system (OPPS): trauma team activation
99291	Critical care, evaluation and management of the critically ill or injured patient; first 30-74 minutes
99285	Emergency department level 5 (example for members who expire shortly after arrival)
045X	Emergency department revenue codes to be billed in addition to trauma activation

Revenue code detailsRevenue

0681	Trauma Response Level
0682	Trauma Response Level
0683	Trauma Response Level
0684	Trauma Response Level
0689	Trauma Response Level

Critical care time threshold

Critical care time thresholdAt least 30 minutes of critical care on the same date of service is required to report CPT 99291 and HCPCS G0390 each with one unit

Less than 30 minutesIf critical care is administered for less than 30 minutes during a trauma activation, the facility may report a charge under revenue code(s) 068x but should not report G0390

Same date of service requirementCritical care and trauma response team reporting (99291 and G0390) must be on the same date of service as the trauma activation

Billing prerequisites and documentation requirements

Billing Rule

Trauma activation billing prerequisites — pre-arrival notification and designated center requirement

Use revenue code 068x only for designated trauma centers when pre-arrival notification from a pre-hospital caregiver has been received; do not bill revenue code 068x if the member self-presents (driven or walks in) without notification. When pre-arrival notification occurred, use FL 14 Type of Admission/Visit code 05. Non-designated trauma centers must not use FL 14 Type 05 or revenue code 068x when billing for trauma services.

Revenue code series 068x corresponds to trauma response levels (0681, 0682, 0683, 0684, 0689).
Use FL 14 Visit Code 05 when pre-arrival notification occurred.
Do not bill 068x for patients who self-present without pre-arrival notification; non-designated centers must not bill 068x or FL 14 Type 05 for trauma services.

Key definitions

Trauma activation team

DefinitionStaff who receive pre-hospital notification and assemble prior to the member's arrival

Team compositionMay be a single- or multi-tiered response team; activation level is assigned by the facility's trauma designation

Activation driversActivation levels are determined by physiologic, anatomic, mechanism criteria, and other factors (e.g., age, anticoagulation, burns)

Facility requirementsTrauma centers and hospitals must be licensed, designated, or authorized by the state to operate trauma activation teams

Highest level trauma activation

Triggering physiologic criteriaConfirmed systolic blood pressure <90 mm Hg in adults (age-specific hypotension in children)