Outpatient Facility Revenue Code Billing Requirements - Facility
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Governance of reporting CPT/HCPCS codes and modifiers with outpatient facility revenue codes for claim submission; applies to facilities submitting outpatient facility claims to Blue Cross Blue Shield - Wisconsin unless overridden by contracts or state/federal requirements.
Added clarifying language for additional revenue codes and added Revenue Code 0300 to the Related Coding section.
Added revenue codes to the Related Coding section to require HCPCS or CPT codes when submitted for reimbursement and added Kentucky and Maine exemptions.
Definitions section updated to add Modifiers.
Reporting requirements and exemptions
Reporting requirements and exemptions
Facilities must report current and valid CPT/HCPCS codes with revenue codes in these circumstances:
State-specific exemptions
- Kentucky: BCBS does not require a corresponding HCPCS or CPT code for revenue codes 0270-0277 and 0279.
- Maine: BCBS does not require a corresponding HCPCS or CPT code for revenue codes 0270-0277, 0279-0280, 0920, and 0940.
- Wisconsin: Anthem BCBS does not require a corresponding HCPCS or CPT code for revenue code 0300.
Revenue codes and coding requirements
| 0270 | Medical/Surgical Supplies and Devices - General (Requires a corresponding HCPCS or CPT) |
| 0271 | Medical/Surgical Supplies and Devices - Nonsterile (Requires a corresponding HCPCS or CPT) |
| 0272 | Medical/Surgical Supplies and Devices - Sterile (Requires a corresponding HCPCS or CPT) |
| 0273 | Medical/Surgical Supplies and Devices - Take-home supplies (Requires a corresponding HCPCS or CPT) |
| 0274 | Medical/Surgical Supplies and Devices - Prosthetic/orthotic devices (Requires a corresponding HCPCS or CPT) |
| 0275 | Medical/Surgical Supplies and Devices - Pacemaker (Requires a corresponding HCPCS or CPT) |
| 0276 | Medical/Surgical Supplies and Devices - Intraocular lens (Requires a corresponding HCPCS or CPT) |
| 0277 | Medical/Surgical Supplies and Devices - Take-Home Oxygen (Requires a corresponding HCPCS or CPT) |
| 0279 | Medical/Surgical Supplies and Devices - Other supplies/devices (Requires a corresponding HCPCS or CPT) |
| 0280 | Oncology - General (Requires a corresponding HCPCS or CPT) |
Billing, documentation, and authorization rules for facilities
Report CPT/HCPCS with revenue codes and bill modifiers — risk of denial for noncompliance
Facilities must report current and valid CPT or HCPCS codes with all revenue codes on outpatient facility claims and bill applicable modifiers; failure to follow these requirements may result in claim rejection, denial, or recovery of payment.
- Report current and valid CPT or HCPCS with all revenue codes on outpatient facility claims unless provider, state, or federal contracts/requirements indicate otherwise.
- Report CPT/HCPCS for revenue codes identified with a 'Y' indicator by the National Uniform Billing Committee (NUBC) and for the specific revenue codes listed in the related coding section (e.g., 0270–0276, 0277, 0279, 0280, 0300, 0920, 0940).
- Bill applicable modifiers on outpatient facility claims where required.
- Noncompliance may result in claim rejection, denial, or recovery/recoupment of payment.
Defined terms used in this policy
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