CurrentBlue Cross Blue Shield - WisconsinPolicy N/A

Operating Room (OR) - Time and Procedure Charges included in an Invasive Procedure

Defines how operating room charges are calculated and what they include for facility reimbursement; applies to Anthem Blue Cross and Blue Shield facility claims and affected members under their benefit terms.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyOperating Room (OR) - Time and Procedure Charges included in an Invasive Procedure

Policy CodePolicy N/A

Change TypeNo material change

Effective DateAug 1, 2008

Next Review DateN/A

Key ActionWhen time is the basis for the charge, calculate from patient entry to exit as documented in OR nurse's notes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

time-or-procbasis for OR reimbursement

entry-to-exittime interval used

nursing-suppliesincluded services

member-termscoverage limits

Operating Room Reimbursement Criteria

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyOperating Room (OR) - Time and Procedure Charges included in an Invasive Procedure

Policy CodePolicy N/A

Change TypeNo material change

Effective DateAug 1, 2008

Next Review DateN/A

Key ActionWhen time is the basis for the charge, calculate from patient entry to exit as documented in OR nurse's notes.

SourceLink

On This Page

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.

Reimbursement is provided on a time-based or procedure-based basis.

ALL of the following

If time-based billing is used, time is calculated from when the patient enters the operating room until the patient leaves the operating room, as documented in the OR nurse's notes.

ALL of the following

OR reimbursement reflects (examples, not limited to):
- Use of the operating room.
- All nursing care provided.
- Preparation (set-up) charges.
- Clean-up charges.
- Special procedures room charge.
- Basic equipment and supplies.
- Services of qualified professionals and technical personnel.
- Linen packs, basic instrument packs, basic post-op dressing, and routine supplies such as sutures, gloves, dressings, sponges, prep kits, drapes, surgical attire.

Coverage and reimbursement are subject to applicable federal and state laws and the terms, conditions, and limitations of the member's benefits on the date of service.

Documentation and Billing Basis

Documentation Required

Document OR time from patient entry to exit in OR nurse's notes

When time is the basis for the operating room charge, calculate total OR time from the moment the patient enters the room until the patient leaves the room as documented in the OR nurse's notes. Reimbursement is subject to federal and state laws and the terms, conditions, and limitations of the member's benefits on the date of service.

Use the OR nurse's notes as the authoritative source for entry and exit times.
Ensure billing reflects the documented entry-to-exit interval exactly.
Confirm member benefit terms and applicable laws before finalizing reimbursement.

Operating Room Charges Definition

Operating room charges

Definition of operating room chargesServices provided to patients by specifically trained nursing personnel or other qualified professionals employed by the short-term general facility who assist a surgeon

Includes supplies and procedure-related servicesAlso includes any other services and supplies specifically related to a surgical procedure (e.g., linen packs, instrument packs, post-op dressing, sutures, gloves, dressings, sponges, prep kits, drapes, surgical attire)

Scope of facility resources reflectedUse of the operating room and all nursing care provided, preparation (set-up) and clean-up charges, special procedures room charge, basic equipment and supplies, and services of qualified professionals and technical personnel

OpenPayer

Operating Room (OR) - Time and Procedure Charges included in an Invasive Procedure

Operating Room Reimbursement Criteria

Billing Basis and Time Calculation

Documentation and Billing Basis

Operating Room Charges Definition