CurrentBlue Cross Blue Shield - WisconsinPolicy C-20005

Treatment Rooms - Facility

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Governs reporting and reimbursement of treatment room revenue codes (0760, 0761, 0769) in outpatient facility claims for commercial members; applies to providers submitting facility outpatient claims to Blue Cross Blue Shield - Wisconsin unless superseded by provider, state, or federal mandates.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyTreatment Rooms - Facility

Policy CodePolicy C-20005

Change TypeRevised (material changes and state-specific addition)

Effective DateJul 1, 2026

Last ReviewFeb 16, 2026

Next Review DateN/A

Key ActionReport CPT or HCPCS codes when billing treatment room revenue codes on UB-04 to avoid denial.

SourceLink

POLICY UPDATE CHANGES

Updated title and added language clarifying new or established patient and consultation E/M services are not reimbursed when reported with revenue codes 0760, 0761, or 0769.

Added prohibition on reimbursement for revenue codes 0760, 0761, and 0769 when billed with Emergency Room (045X), Outpatient Surgery (036X), Recovery Room (071X), Observation (0762), Clinic (051X).

Wisconsin-specific exemption allowing revenue codes 0760, 0761, and 0769 when billed with Clinic (051X) or Freestanding Clinic (052X).

3treatment room revenue codes

6prohibited room combos (national)

1WI state exception

Standardcoding requirement

Coverage and Billing Rules

Coverage and billing rules for treatment room revenue codes

Policy determines when treatment room revenue codes are not reimbursed and identifies a Wisconsin exception.

Do not reimburse new or established patient office evaluation and management (E/M) or consultation CPT/HCPCS service codes when reported with revenue codes 0760, 0761, or 0769.

ALL of the following

Emergency Room (045X)
Outpatient Surgery (036X)
Recovery Room (071X)
Observation (0762)
Clinic (051X)
Freestanding Clinic (052X)

State-specific exception (Wisconsin): In Wisconsin, revenue codes 0760, 0761, and 0769 are allowed when billed on the same claim with Clinic (051X) or Freestanding Clinic (052X).

Revenue codes 0760, 0761, and 0769 must be reported with an accompanying CPT or HCPCS code on the UB-04; facility lines missing an accompanying procedure code may be denied or recouped.

Revenue Codes and Coding Requirements

Revenue codes with reimbursement rulesRevenue

0760	Treatment room revenue code
0761	Treatment room revenue code
0769	Other treatment room revenue code
045X	Emergency Room revenue code
036X	Outpatient Surgery revenue code
071X	Recovery Room revenue code
0762	Observation revenue code
051X	Clinic revenue code
052X	Freestanding Clinic revenue code

Required accompanying procedure code presence

RequirementRevenue codes 0760, 0761, and 0769 must be reported with an accompanying CPT® or HCPCS code on the UB‑04/facility claim; facility lines missing the accompanying procedure code may be denied.

ScopeApplies to treatment room revenue codes billed in an outpatient facility setting for commercial members unless provider, state, federal contracts or mandates indicate otherwise.

ConsequenceFailure to report the required CPT/HCPCS on the UB‑04 can result in denial or non‑reimbursement of the facility line.

Related policy statementThe health plan requires the reporting of CPT® or HCPCS codes for treatment room revenue codes in an outpatient facility setting.

Provider Reporting and Denial Risk

Denial Risk

Required reporting and denial risk for treatment room codes

When billing treatment room revenue codes (0760, 0761, 0769) on an outpatient facility claim, report the accompanying CPT® or HCPCS procedure code on the UB‑04; failure to report the CPT/HCPCS may result in denial or nonreimbursement. The plan also will not reimburse new or established patient office E/M or consultation CPT/HCPCS codes when those codes are reported with revenue codes 0760, 0761, or 0769, and will not reimburse 0760/0761/0769 when billed on the same claim with Emergency Room (045X), Outpatient Surgery (036X), Recovery Room (071X), Observation (0762), Clinic (051X), or Freestanding Clinic (052X).

Report CPT® or HCPCS codes with treatment room revenue codes on outpatient facility claims or risk denial.
New/established patient office E/M or consultation codes reported with 0760, 0761, or 0769 are not reimbursed.
Revenue codes 0760/0761/0769 billed on the same claim with 045X, 036X, 071X, 0762, 051X, or 052X are not reimbursed.

Definitions and State-specific Notes

Related coding / state exception

DefinitionTreatment Rooms policy — defines rules for reporting and reimbursement of treatment room revenue codes in facility outpatient claims (C‑20005).

Standard codingStandard correct coding applies to reporting revenue codes and accompanying procedure codes.

State exception (Wisconsin)Anthem Blue Cross Blue Shield — Wisconsin allows revenue codes 0760, 0761, and 0769 when billed on the same claim with Clinic (051X) or Freestanding Clinic (052X).

Policy noteDespite the Wisconsin exception, the general policy disallows reimbursement when 0760/0761/0769 are billed with certain other room codes (e.g., 045X, 036X, 071X, 0762).

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyTreatment Rooms - Facility

Policy CodePolicy C-20005

Change TypeRevised (material changes and state-specific addition)

Effective DateJul 1, 2026

Last ReviewFeb 16, 2026

Next Review DateN/A

Key ActionReport CPT or HCPCS codes when billing treatment room revenue codes on UB-04 to avoid denial.

SourceLink

On This Page

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Treatment Rooms - Facility

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Sign up for Blue Cross Blue Shield - Wisconsin Policy C-20005 alerts

Get alerted when Policy C-20005 changes without checking for updates manually.

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Coverage and Billing Rules

Coverage and billing rules for treatment room revenue codes

Policy determines when treatment room revenue codes are not reimbursed and identifies a Wisconsin exception.

Do not reimburse new or established patient office evaluation and management (E/M) or consultation CPT/HCPCS service codes when reported with revenue codes 0760, 0761, or 0769.

ALL of the following

Emergency Room (045X)
Outpatient Surgery (036X)
Recovery Room (071X)
Observation (0762)
Clinic (051X)
Freestanding Clinic (052X)

State-specific exception (Wisconsin): In Wisconsin, revenue codes 0760, 0761, and 0769 are allowed when billed on the same claim with Clinic (051X) or Freestanding Clinic (052X).

Revenue codes 0760, 0761, and 0769 must be reported with an accompanying CPT or HCPCS code on the UB-04; facility lines missing an accompanying procedure code may be denied or recouped.

Revenue Codes and Coding Requirements

Revenue codes with reimbursement rulesRevenue

0760	Treatment room revenue code
0761	Treatment room revenue code
0769	Other treatment room revenue code
045X	Emergency Room revenue code
036X	Outpatient Surgery revenue code
071X	Recovery Room revenue code
0762	Observation revenue code
051X	Clinic revenue code
052X	Freestanding Clinic revenue code

Required accompanying procedure code presence

ScopeApplies to treatment room revenue codes billed in an outpatient facility setting for commercial members unless provider, state, federal contracts or mandates indicate otherwise.

ConsequenceFailure to report the required CPT/HCPCS on the UB‑04 can result in denial or non‑reimbursement of the facility line.

Related policy statementThe health plan requires the reporting of CPT® or HCPCS codes for treatment room revenue codes in an outpatient facility setting.

Provider Reporting and Denial Risk

Denial Risk

Required reporting and denial risk for treatment room codes

Report CPT® or HCPCS codes with treatment room revenue codes on outpatient facility claims or risk denial.
New/established patient office E/M or consultation codes reported with 0760, 0761, or 0769 are not reimbursed.
Revenue codes 0760/0761/0769 billed on the same claim with 045X, 036X, 071X, 0762, 051X, or 052X are not reimbursed.

Definitions and State-specific Notes

Related coding / state exception

DefinitionTreatment Rooms policy — defines rules for reporting and reimbursement of treatment room revenue codes in facility outpatient claims (C‑20005).

Standard codingStandard correct coding applies to reporting revenue codes and accompanying procedure codes.

State exception (Wisconsin)Anthem Blue Cross Blue Shield — Wisconsin allows revenue codes 0760, 0761, and 0769 when billed on the same claim with Clinic (051X) or Freestanding Clinic (052X).

Policy noteDespite the Wisconsin exception, the general policy disallows reimbursement when 0760/0761/0769 are billed with certain other room codes (e.g., 045X, 036X, 071X, 0762).