CurrentFlorida BluePolicy N/A

HCPCS Codes Required with Certain Implant/Device Revenue Codes on Claims

This reimbursement policy governs outpatient claim submission when specific implant or device revenue codes (UB04) are billed to Florida Blue; providers must include the applicable HCPCS codes identifying the implant/device to receive payment for those line items.

Policy Summary

PayerFlorida Blue

PolicyHCPCS Codes Required with Certain Implant/Device Revenue Codes on Claims

Policy CodePolicy N/A

Change TypeAdded enforcement of HCPCS inclusion

Effective DateDec 1, 2023

Next Review DateN/A

Key ActionInclude the applicable HCPCS code on outpatient claims when billing revenue codes 274, 275, 276, 278 or 624 to avoid denial of that service line.

SourceLink

POLICY UPDATE CHANGES

Effective December 1, 2023, claims with certain implant/device revenue codes missing the required HCPCS code will no longer include payment for the related service line.

5revenue codes listed that require HCPCS

Dec 1, 2023enforcement effective

denialsconsequence when omitted

Coverage Criteria

HCPCS inclusion requirement

Claims billing the listed UB04 revenue codes for outpatient services must include the applicable HCPCS code to be paid for that service line.

When billing outpatient services using any of the listed UB04 revenue codes, the claim must include the applicable HCPCS code that identifies the specific implant or device.

Revenue codes

Revenue code 274 — Prosthetic Devices
Revenue code 275 — Pacemakers
Revenue code 276 — Intraocular Lens

Policy Summary

PayerFlorida Blue

PolicyHCPCS Codes Required with Certain Implant/Device Revenue Codes on Claims

Policy CodePolicy N/A

Change TypeAdded enforcement of HCPCS inclusion

Effective DateDec 1, 2023

Next Review DateN/A

Key ActionInclude the applicable HCPCS code on outpatient claims when billing revenue codes 274, 275, 276, 278 or 624 to avoid denial of that service line.

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.

Coding and Billing Codes

UB04 revenue codes requiring HCPCSRevenue

274	Prosthetic Devices (revenue code)
275	Pacemakers (revenue code)
276	Intraocular Lens (revenue code)
278	Other Implants (revenue code)
624	FDA Investigational Devices (revenue code)

HCPCS requirement enforcement date

Enforcement effective dateEffective December 1, 2023 — claims submitted with the listed implant/device revenue codes missing the required HCPCS code will no longer include payment for that service line

Operational consequenceAffected claim line items will deny until resubmitted with the required HCPCS codes

ScopeApplies to outpatient services billed with revenue codes 274, 275, 276, 278, 624

Provider Actions / Billing Requirements

Billing Rule

Claim submission requirement — include HCPCS with implant/device revenue codes

Include the applicable HCPCS code on outpatient claims when billing any of the listed implant/device UB04 revenue codes (274, 275, 276, 278, 624). Omission of the HCPCS code for these revenue codes will result in nonpayment for the related service line until the claim line is resubmitted with the required HCPCS.

Applies to revenue codes: 274 (Prosthetic Devices), 275 (Pacemakers), 276 (Intraocular Lens), 278 (Other Implants), 624 (FDA Investigational Devices).
Effective December 1, 2023, affected claim line items will deny and not include payment until submitted with the required HCPCS.

Definitions (Revenue Code Examples)

Prosthetic Devices (Revenue code 274)

Revenue code274

DescriptionProsthetic Devices

Claim requirementInclude the applicable HCPCS code when billing revenue code 274 for outpatient services to avoid incorrect reimbursement or denial

Pacemakers (Revenue code 275)

Revenue code275

DescriptionPacemakers

Claim requirementInclude the applicable HCPCS code when billing revenue code 275 for outpatient services to avoid incorrect reimbursement or denial

Intraocular Lens (Revenue code 276)

Revenue code276

DescriptionIntraocular Lens

Claim requirementInclude the applicable HCPCS code when billing revenue code 276 for outpatient services to avoid incorrect reimbursement or denial

Other Implants (Revenue code 278)

Revenue code278

DescriptionOther Implants (types of implants that do not fall into the four codes above)

Claim requirementInclude the applicable HCPCS code when billing revenue code 278 for outpatient services to avoid incorrect reimbursement or denial

FDA Investigational Devices (Revenue code 624)

Revenue code624

DescriptionFDA Investigational Devices

Claim requirementInclude the applicable HCPCS code when billing revenue code 624 for outpatient services to avoid incorrect reimbursement or denial