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Labs related to outpatient surgery not separately reimbursed
May 1, 2021

This article is for acute care hospitals where our members receive outpatient surgery

Blue Cross reimburses for outpatient surgical services as outlined in our existing outpatient surgical services facility payment policy.

As a reminder, we reimburse outpatient surgical services at a case rate, which reflects the fee for each allowable surgery, including laboratory services related to the surgery.

The existing outpatient surgical services facility payment policy states that Blue Cross:

  • Separately reimburses laboratory, radiology, or other diagnostic tests or procedures that are unrelated to the surgical procedure.
  • Does not separately reimburse services, such as laboratory, that are related to the allowable surgical procedure. Reimbursement is included as part of the surgical case rate.

Payment policy application

  • Enforcement of this payment policy will occur through post-payment reviews.
  • In the third quarter of 2021, we will have the ability to process claims in accordance with this policy pre-payment, which will reduce the number of claims being reviewed post-payment.

Important billing reminders

  • Bill all CPT and HCPCS codes with the appropriate revenue code to trigger the correct surgery case rate.
  • Bill all facility services administered on the day of the surgery on the same claim form to ensure accurate reimbursement. Certain services should be billed on individual lines so they can be individually priced.
  • Bill multiple surgeries on the same claim form with the appropriate revenue codes and corresponding valid CPT or HCPCS surgical procedure codes.

See payment policy for additional billing guidelines.


Call Provider Service at 1-800-882-2060. As always, thank you for the care you provide to your patients—our members.


 Outpatient surgical services facility payment policy (log in and go to Office Resources>Policies & Guidelines>Payment Policies)