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Billing Reminder for Outpatient and Ambulatory Surgery Centers: BCBSNC Requires CPT and HCPCS Codes to Be Included On UB-04 Claim Submissions



Blue Cross and Blue Shield of North Carolina (BCBSNC) would like to remind filers of outpatient and ambulatory surgical center services that all appropriate CPT and HCPCS codes are to be included when reporting services to BCBSNC. Claims for outpatient services require CPT and HCPCS codes at the line level of the UB-04 and must be billed with both revenue codes and appropriate CPT or HCPCS codes when applicable codes exist. Appropriate revenue codes must be placed in Form Locator 42 for each line item. CPT and HCPCS codes are assigned in Form Locator 44. Outpatient hospital and ambulatory surgery centers must include CPT/HCPCS codes in Form Locator 44 to describe specific procedures, when and if, appropriate codes are available. If multiple CPT or HCPCS codes are necessary to reflect multiple, distinct, or independent services matching a single revenue code, claims should be coded to repeat that revenue code, as necessary.

BCBSNC first introduced this policy in October 2009 and has been monitoring claim submissions and working with network providers to ensure rule adherence. Upgrades to system edits will take place later this month and will assist BCBSNC with identifying instances of non-adherence. If you are a filer of outpatient services and not currently reporting CPT/HCPCS codes on your outpatient UB-04 claim submissions, please be aware that effective October 1, 2011 our newly installed edits will begin rejecting those claims from processing.