Revenue Codes Requiring Procedure Codes, Facility Notification
Origination Date: June 1, 2022
Last Review Date: September 1, 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.
Blue Cross NC requires revenue codes be submitted with an appropriate corresponding CPT® or HCPCS code; consistent with CMS, Uniform Billing Editor (UBE), 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 codes.
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.
Related policy
Facility Billing Guidelines
References
Centers for Medicare and Medicaid Services and CMS Manual System
Healthcare Common Procedure Coding System, HCPCS Release and Code Sets
National Uniform Billing Committee (NUBC)
https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs
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. (cjw) |
| 1/1/2026 | Updated Application section to include Healthy Blue + Medicare (HMO-POS D-SNP). Notification on 11/1/2025 for effective date 1/1/2026. (dc) |
| 12/15/2026 | 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 Blue Medicare HMO, Blue Medicare PPO, Blue Medicare Rx members, Healthy Blue + Medicare (HMO-POS D-SNP), and members of any third-party Medicare plans supported by Blue Cross NC through administrative or operational services.
This policy relates only to the services or supplies described herein. Please refer to the Member's Evidence of Coverage (EOC) 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.