CurrentEmpire BluecrossPolicy C-18003

Facility outpatient claims coding and billing requirements

Defines Anthem/Empire BlueCross requirements for reporting CPT/HCPCS codes and revenue codes on outpatient facility claims, and billing applicable modifiers; applies to facilities submitting claims to the payer.

Policy Summary

PayerEmpire Bluecross

PolicyFacility outpatient claims coding and billing requirements

Policy CodePolicy C-18003

Change TypeAdded revenue codesDefinitions updated

Effective Date11/01/2024

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 revenue codes to the Related Coding section to require HCPCS or CPT codes when submitted for reimbursement.

Definitions section updated to add Modifiers.

Added Outpatient to Title, References and Research Materials, Related Policies and Materials.

C-18003document identifier

06/12/2024last approval

11/01/2024effective date

0270-0280, 0920, 0940revenue codes

Outpatient Facility Billing and Coding Criteria

Outpatient facility billing and coding criteria

Claims submission requirements for outpatient facility services

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

When appropriate CPT or HCPCS codes are available, the facility shall report current and valid CPT or HCPCS codes for the remaining revenue codes.

The facility shall bill applicable modifiers on outpatient facility claims.

Specific NUBC revenue codes requiring corresponding CPT/HCPCS

0270 — Medical/Surgical Supplies and Devices General (Requires a corresponding HCPCS or CPT).

Policy Summary

PayerEmpire Bluecross

PolicyFacility outpatient claims coding and billing requirements

Policy CodePolicy C-18003

Change TypeAdded revenue codesDefinitions updated

Effective Date11/01/2024

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

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.

Revenue, CPT/HCPCS and Coding Requirements

Revenue codes requiring CPT/HCPCSRevenueCovered

0270	Medical/Surgical Supplies and Devices General — Requires corresponding HCPCS or CPT
0271	Medical/Surgical Supplies and Devices Nonsterile — Requires corresponding HCPCS or CPT
0272	Medical/Surgical Supplies and Devices Sterile — Requires corresponding HCPCS or CPT
0273	Medical/Surgical Supplies and Devices Take-home supplies — Requires corresponding HCPCS or CPT
0274	Medical/Surgical Supplies and Devices Prosthetic/orthotic devices — Requires corresponding HCPCS or CPT
0275	Medical/Surgical Supplies and Devices Pacemaker — Requires corresponding HCPCS or CPT
0276	Medical/Surgical Supplies and Devices Intraocular lens — Requires corresponding HCPCS or CPT
0277	Medical/Surgical Supplies and Devices Take-Home Oxygen — Requires corresponding HCPCS or CPT
0279	Medical/Surgical Supplies and Devices Other supplies/devices — Requires corresponding HCPCS or CPT
0280	Oncology General — Requires corresponding HCPCS or CPT

1–10 of 12

1/2

Coding requirement — Current and valid CPT or HCPCS codes must be reported with all revenue codes on outpatient facility claims unless contracts or law indicate otherwise

Coding requirementAnthem requires facilities to report current and valid CPT or HCPCS codes with all revenue codes on outpatient facility claims unless provider, state, or federal contracts or law indicate otherwise. Facilities must also report current and valid CPT or HCPCS codes for the remaining revenue codes when appropriate codes are available, and bill applicable modifiers on outpatient facility claims.

Billing and Modifier Requirements for Providers

Billing Rule

Outpatient facility coding and modifier requirements

Facilities must report current and valid CPT or HCPCS codes with all revenue codes on outpatient facility claims unless provider, state, or federal contracts and/or requirements indicate otherwise. The facility must also report current and valid CPT or HCPCS codes for remaining revenue codes when appropriate CPT or HCPCS codes are available, and bill the applicable modifiers on outpatient facility claims.

Report current and valid CPT or HCPCS codes with all revenue codes on outpatient facility claims unless overridden by provider, state, or federal contracts or requirements.
Report CPT or HCPCS codes for remaining revenue codes when appropriate codes are available.
Bill applicable modifiers on outpatient facility claims.

Key Terms and Definitions

Modifiers

DefinitionTwo-digit code that provides additional information about the medical procedure, service, or supply involved without changing the meaning of the code.

Use on claimsBill applicable modifiers on outpatient facility claims as part of facility billing requirements.

Relation to CPT/HCPCSModifiers are reported alongside CPT or HCPCS codes to give additional details about the service performed.

Revenue Code

DefinitionUnique 4-digit numbers that are descriptions and dollar amounts charged for hospital services provided to a patient.

UsageRevenue codes are reported on institutional (facility) claims to describe the type of service or charge.

Link to coding requirementCertain NUBC revenue codes require corresponding CPT or HCPCS codes when submitted for reimbursement.

National Uniform Billing Committee (NUBC)

RoleDevelop and maintain a single billing form and standard data set to be used nationwide by institutional, private, and public providers and payers for handling health care claims.

StandardsNUBC requirements specify when revenue codes must be accompanied by CPT or HCPCS codes on outpatient facility claims.

ScopeApplies to institutional billing practices and standardization of claim data elements.