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Enforcement of Lithotripsy Billing and Claims Submission Guidelines

Release Date: December 21, 2012

Blue Cross and Blue Shield of North Carolina (BCBSNC) provides comprehensive information to assist network participating health care providers to file claims in accordance with our claim submission guidelines.  By following claim submission guidelines providers can help to improve the quality of the claims we receive, which allows BCBSNC to process and pay claims faster and more efficiently.

Recently we discovered that providers of Lithotripsy services may not be consistently following BCBSNC’s guidelines for billing global charges.  Lithotripsy services are typically covered under a direct contract with a provider who performs the lithotripsy services.  Lithotripsy providers are reimbursed at a global rate for most services related to lithotripsy.  Subsequently, lithotripsy services administered by a provider operating at a facility are not separately billable by the facility, and should not be reported outside of the performing provider’s claim for the lithotripsy service.

BCBSNC does not allow for additional payment beyond the global allowance when reporting of global services is appropriate.

A listing of lithotripsy services included versus excluded, can be found in the Provider Blue Book e-Manual available on the provider portal of our Web site at http://www.bcbsnc.com/providers.

For more information regarding lithotripsy, please refer to our corporate medical policy online at http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/extracorporeal_shock_wave_treatment_for_musculoskeletal_conditions_and_wound_healing.pdf.