CurrentBlue Cross Blue Shield - WisconsinPolicy C-18003

Outpatient Facility Revenue Code Billing Requirements - Facility

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.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyOutpatient Facility Revenue Code Billing Requirements - Facility

Policy CodePolicy C-18003

Change TypeClarified coding requirementsadded revenue codes and state exemptions

Effective Date05/01/2026

Next Review Date

Key ActionFacilities must report current and valid CPT or HCPCS codes with all revenue codes on outpatient facility claims and bill applicable modifiers.

SourceLink

POLICY UPDATE CHANGES

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.

MultipleRevenue codes requiring CPT/HCPCS

3States with exemptions

C-18003Identifier

2026-05-01Effective

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.

Reporting requirements and exemptions

Facilities must report current and valid CPT/HCPCS codes with revenue codes in these circumstances:

Report current and valid CPT or HCPCS with all revenue codes on outpatient facility claims unless provider, state, or federal contracts or requirements indicate otherwise.

Report CPT/HCPCS for revenue codes identified with a 'Y' indicator by the National Uniform Billing Committee (NUBC).

Report CPT/HCPCS for the specific revenue codes listed in the related coding section (examples include 0270-0276, 0277, 0279, 0280, 0300, 0920, 0940).

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.

Facilities shall bill applicable modifiers on outpatient facility claims where appropriate.

Failure to follow these coding and billing guidelines may result in claim rejection, denial, or recovery/recoupment of payment.

This policy may be superseded by provider, state, federal, or CMS contracts and requirements.

Revenue codes and coding requirements

Revenue codes requiring corresponding CPT/HCPCSmixedCovered

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)

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NUBC 'Y' indicator requirement — Reporting CPT/HCPCS with revenue codes

RequirementFacility must report CPT or HCPCS for revenue codes the NUBC identifies with a 'Y' indicator and for revenue codes listed in the Related Coding section (e.g., 0270-0276, 0277, 0279, 0280, 0300, 0920, 0940)

ScopeApplies to outpatient facility claims unless provider, state, or federal contracts/requirements indicate otherwise

ConsequenceFailure to report required CPT/HCPCS may result in claim rejection, denial, or recovery of payment

Billing, documentation, and authorization rules for facilities

Billing Rule

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

NUBC (term / definition)

TermNational Uniform Billing Committee (NUBC)

DefinitionDevelops and maintains a single billing form and standard data set used nationwide by institutional, private, and public providers and payers for handling health care claims.

RoleIdentifies revenue codes (e.g., via a 'Y' indicator) for which facilities must report corresponding CPT/HCPCS codes

Revenue Code (term / definition)

TermRevenue Code

DefinitionUnique 4-digit numbers that describe services and denote dollar amounts charged for hospital services provided to a patient (examples in this policy include 0270, 0271, 0272, 0273, 0274, 0275, 0276, 0277, 0279, 0280, 0300, 0920, 0940)

UsageUsed on outpatient facility claims and may require a corresponding CPT or HCPCS code per this policy

Modifier (term / definition)

TermModifier

DefinitionBilling modifier that shall be billed on outpatient facility claims where applicable (added to Definitions section in 2023 update)

RequirementFacilities shall bill applicable modifiers on outpatient facility claims as required by this policy