Revenue Codes Requiring Procedure Codes, Facility Notification
Origination Date: 06/2022
Last Review Date: 09/2026
Description
This policy defines revenue codes that Blue Cross Blue Shield North Carolina (Blue Cross NC) require a CPT® or HCPCS procedure code be reported.
This policy applies to UB-04 and 837-institutional claim forms.
Policy
Blue Cross NC will reimburse revenue codes according to the criteria outlined in this policy.
Reimbursement Guidelines
Blue Cross NC enforces the revenue code list requiring a corresponding CPT®/HCPCS found within the most recent CMS OCE edit. Please refer to the Reference section for the current revenue code list from CMS. In addition to the revenue codes from CMS, Blue Cross NC requires the additional revenue codes listed in the Billing and Coding section to be submitted with a corresponding CPT®/HCPCS.
Blue Cross NC requires revenue codes be submitted with an appropriate corresponding CPT®/HCPCS code; consistent with CMS, Uniform Billing Editor, and the UB-04 manual. Revenue codes are not reimbursable when an inappropriate HCPCS or CPT® code is submitted, with or without a modifier.
Multiple lines of the same revenue codes are required to represent different CPT® or HCPCS.
Bill Types requiring revenue codes with a corresponding CPT®/HCPCS include 012x, 013x, 014x, 074x, 075x, 076x and 083x.
Billing and Coding
Applicable codes are for reference only and may not be all inclusive. For further information on reimbursement guidelines, please see the Blue Cross NC web site at www.bcbsnc.com.
Please refer to the current OCE release for CMS’s list of revenue codes requiring CPT®/HCPCS.
Additional Revenue Codes Requiring CPT®/HCPCS
| Revenue Code | Description |
| 254 | Pharmacy |
| 255 | Pharmacy |
| 260 | IV Therapy |
| 275 | Pacemaker |
| 276 | Intraocular Lens |
| 278 | Other Implants |
| 390 | Admin, Processing, and Storage for blood and blood components |
| 392 | Admin, Processing, and Storage for blood and blood components |
| 399 | Admin, Processing, and Storage for blood and blood components |
| 732 | EKG/ECG |
| 762 | Observation Room |
| 821 | Hemodialysis- OP or Home |
| 829 | Hemodialysis- OP or Home |
| 905 | Behavioral Health Tx/Services |
| 906 | Behavioral Health Tx/Services |
| 907 | Behavioral Health Tx/Services |
| 940 | Other Therapeutic Services |
| 942 | Other Therapeutic Services |
| 943 | Other Therapeutic Services |
Related policy
Facility Billing Guidelines
References
Centers for Medicare and Medicaid Services, CMS Manual System
Healthcare Common Procedure Coding System (HCPCS)
American Medical Association, Current Procedural Terminology (CPT® ) National Uniform Billing Committee (NUBC)
Outpatient Code Editor (OCE) Outpatient Code Editor (OCE) | CMS History
https://www.cms.gov/medicare/coding/outpatientcodeedit
History
| Date | Revision |
| 6/1/2022 | New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. (eel) |
| 12/31/2022 | Routine policy review. Minor revisions only. (ckb) |
| 12/15/2026 | Updated revenue codes requiring HCPCS codes list. Clarified that revenue codes must be submitted with the appropriate HCPCS code. RPOC approved. Notification on 10/15/2026 for effective date 12/15/2026 (ss) |
Application
These reimbursement requirements apply to all commercial, Administrative Services Only (ASO), and Blue Card Inter-Plan Program Host members (other Plans members who seek care from the NC service area).
This policy relates only to the services or supplies described herein. Please refer to the Member's Benefit Booklet for availability of benefits. Member's benefits may vary according to benefit design; therefore member benefit language should be reviewed before applying the terms of this policy.