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. To download this policy, log in and go to Office Resources>Policies & Guidelines>Payment Policies.
As a reminder, we reimburse outpatient surgical services at a case rate, which reflects the fee for each allowable surgery, including diagnostic services directly related to the surgical procedure.
Our 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 diagnostics, that are directly related to the allowable surgical procedure. Reimbursement is included as part of the surgical case rate.
Effective Q3 2023, we will process claims in accordance with our Outpatient Surgical Services — Facility payment policy.
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.
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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