Facility Billing Guidelines Reimbursement Policy Update: Treatment Room Services
Beginning January 1, 2027, Blue Cross NC will no longer separately reimburse outpatient treatment room charges reported with revenue codes 0760, 0761, or 0769 when billed on the same outpatient claim as certain other outpatient facility services.
Treatment room revenue codes 0760, 0761, and 0769 will not be separately reimbursed when reported with revenue codes for:
- Emergency room services, 045x
- Outpatient surgery, 036x
- Recovery room services, 071x
- Observation services, 0762
- Clinic services, 051x
- Freestanding clinic services, 052x
Treatment room charges are considered incidental to the delivery of outpatient care and are included in reimbursement for the primary outpatient facility service. As a result, separate reimbursement will not be allowed when one of the applicable primary outpatient facility services is reported on the same claim.
This change expands existing reimbursement guidance addressing facility charges associated with office- and clinic-based evaluation and management services and treatment room use included in emergency room reimbursement.
Blue Cross NC is implementing this change to support consistent billing practices and reduce the potential for duplicate reimbursement of overlapping outpatient facility charges. See the related Commercial policy notification.
This policy applies to Commercial, Inter-Plan Program (IPP) Host, Medicare Advantage and Federal Employee Program (FEP). This does not apply to IPP Home.