CurrentPremera BluecrossPolicy CP PP 398vL.7

Facility Fees: Clinic Services, Professional Fees and Specialty Services - Treatment Room (Revenue Code 0761 and related)

Defines Plan limitations and non-reimbursement rules for specific clinic and professional revenue codes (including 0761, 0982, 0983 and multiple clinic/freestanding clinic revenue codes) on facility (UB-04/837) claims for Premera Blue Cross lines of business; governs billing and provider write-off treatment.

Policy Summary

PayerPremera Bluecross

PolicyFacility Fees: Clinic Services, Professional Fees and Specialty Services - Treatment Room (Revenue Code 0761 and related)

Policy CodePolicy CP PP 398vL.7

Change TypeClarification: non-reimbursement treated as provider write-off; minor historical edits removed Alaska and COVID exception language.

Effective Date

Next Review Date

Key ActionDo not bill the listed clinic/freestanding clinic revenue codes or revenue codes 0761, 0982, 0983 on facility claims with E&M or HCPCS clinic visit codes — such combinations will not be reimbursed and are treated as provider write-offs.

SourceLink

POLICY UPDATE CHANGES

From exceptions section removed Alaska lines of business and Covid statement from 2023.

Indicated that non-reimbursement of listed Revenue Codes is considered a provider write-off.

Exception for reimbursement of COVID-19 vaccine administration codes during declared Public Health Emergency (historical entry) and later reversal for dates of service on/after July 6, 2023.

~20Revenue codes listed

0761,0982,0983Specific codes called out

09/08/25Last review

Multiple LOBsApplies to

Coverage and Reimbursement Criteria

Non-reimbursable combinations and requirements

The Plan will not reimburse the following when billed on a facility claim (UB-04 or 837 electronic format) in conjunction with E&M CPT codes (99201-99499) or HCPCS clinic visit codes (G0438, G0439, G0463):

Do not reimburse the listed clinic and freestanding clinic revenue codes when billed on a facility claim in conjunction with E&M CPT codes (99201-99499) or HCPCS clinic visit codes (G0438, G0439, G0463). These revenue codes include: 0510, 0511, 0512, 0513, 0514, 0515, 0516, 0517, 0519, 0520, 0521, 0522, 0523, 0526, 0529, 0770, 0771.

Do not reimburse Revenue Code 0982 (Professional Fees Outpatient Clinic) or Revenue Code 0983 (Professional Fees Clinic) when submitted on a facility claim with any E&M CPT code (99201-99499) or HCPCS clinic visit codes (G0438, G0439, G0463).

When any of the above-listed revenue codes are billed in conjunction with E&M/clinic visit codes on the same facility claim, the charges are considered a provider write-off (financial responsibility remains with the provider).

Revenue Code 0761 - Treatment Room

Policy Summary

PayerPremera Bluecross

PolicyFacility Fees: Clinic Services, Professional Fees and Specialty Services - Treatment Room (Revenue Code 0761 and related)

Policy CodePolicy CP PP 398vL.7

Change TypeClarification: non-reimbursement treated as provider write-off; minor historical edits removed Alaska and COVID exception language.

Effective Date

Next Review Date

SourceLink

On This Page

Coding and Revenue Code Details

Non-reimbursable revenue and clinic visit codes combinationsmixedNot Covered

0510-0519, 0520-0529, 0770-0771	Clinic and Freestanding Clinic revenue codes and preventive care service revenue codes listed in policy
0761	Specialty Services - Treatment Room (must be billed with specific procedure CPT/HCPCS; not reimbursed with E&M/clinic visit codes on facility claim)
0982, 0983	Professional Fees Outpatient Clinic / Clinic — not reimbursed when submitted with E&M/clinic visit codes on facility claim
99201-99499	Evaluation and Management CPT codes referenced as triggering non-reimbursement when on facility claims with listed revenue codes
G0438, G0439, G0463	HCPCS clinic visit codes referenced as triggering non-reimbursement when on facility claims with listed revenue codes

Required specificity for Revenue Code 0761 billing

Required procedure codingServices billed with Revenue Code 0761 must be submitted with an applicable specific CPT procedure code or HCPCS Level II code that reflects the actual treatment or surgical procedure(s) rendered in the treatment room.

Applicable CPT rangeWhen billed on a facility claim, Revenue Code 0761 must not be submitted in conjunction with Evaluation and Management CPT codes 99201-99499; instead it requires a specific procedure CPT code.

Applicable HCPCS codesIf using HCPCS, submit a specific Level II HCPCS code that describes the treatment rendered; do not pair 0761 with HCPCS clinic visit codes G0438, G0439, or G0463 on a facility claim.

Claim form formatsRequirements apply when billed on a facility claim form (UB-04) or electronic 837I format.

Treatment specificity requirementThe CPT/HCPCS code submitted with 0761 must reflect the actual treatment or surgical procedure(s) performed in the treatment room.

Billing Rules and Provider Responsibilities

Denial Risk

Do not bill 0761 / 0982 / 0983 with E&M/clinic visit codes

Revenue codes 0761 (Specialty Services - Treatment Room), 0982 (Professional Fees Outpatient Clinic), and 0983 (Professional Fees Clinic) are non-reimbursable when billed on a facility claim together with any Evaluation & Management (E&M) CPT code (99201-99499) or HCPCS clinic visit codes (G0438, G0439, G0463). These revenue codes must instead reflect a specific procedure and be billed with the applicable CPT or HCPCS procedure code. If billed with an E&M/clinic visit on the same facility claim, the revenue will be considered a provider write-off and may result in denial or contractual penalties.

Affected revenue codes: 0761, 0982, 0983
Affected E&M/clinic visit codes: CPT 99201-99499; HCPCS G0438, G0439, G0463
Action required: Submit a specific CPT/HCPCS procedure code for treatment room services rather than billing the above revenue codes with an E&M/clinic visit on the same facility claim.
Consequence: Revenue billed in violation will be processed as a provider write-off; may trigger increased auditing, monitoring, contractual penalties, or termination per payer contract.

Definitions and Administrative Notes

Provider write-off (financial responsibility) when billing prohibited revenue codes with E&M on facility claims

DefinitionProvider write-off: Non-reimbursement of the listed revenue codes (including 0761, 0982, 0983 when billed with E&M/clinic visit codes on a facility claim) is considered a provider write-off.

When it appliesOccurs when listed revenue codes are submitted on a facility claim (UB-04 or 837I) in conjunction with E&M CPT codes (99201-99499) or HCPCS clinic visit codes (G0438, G0439, G0463).

Financial responsibilityThe provider is financially responsible for charges represented by those revenue codes when they meet the non-reimbursable combination criteria — charges are not paid by the Plan and are treated as write-offs.

Contract and enforcementViolations may prompt increased auditing, monitoring, contractual penalties, or termination as determined by the Plan.