This article is for acute care facilities caring for our members
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 and services considered included in the allowable reimbursement.
Our current 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 considered included in the surgical case rate, such as:
- Primary surgical dressings, supplies, splints, casts, appliances, and other equipment directly related to the performance of the surgical procedure.
- Please see our Outpatient Surgical Services – Facility payment policy for additional examples of services included in the allowable reimbursement.
As of Q2 2024, services that are not separately reimbursable from the surgical case rate will process in accordance with our existing payment policy. This will help reduce the number of claims that will require a post-payment review.
Important billing reminders
Be sure to bill:
- CPT and HCPCS codes with the appropriate revenue code to trigger the correct surgical case rate.
- Facility services administered on the day of the surgery on the same claim form to ensure accurate reimbursement.
- Multiple surgeries on the same claim form with the appropriate revenue codes and corresponding valid CPT or HCPCS surgical procedure codes.
See our Outpatient Surgical Services – Facility payment policy for additional billing guidelines.
To download our payment policies, log in and click Find a Payment Policy on the right side of your home page. Or, go to Office Resources>Policies & Guidelines>Payment Policies.
Questions?
If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.
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