Reimbursements

Category:

Payment for Generic Revenue Codes

Reimbursement Policy: NDRP-Misc-002
Topic:       Payment for Generic Revenue Codes   
Effective Date:  July 1, 2019
Last Reviewed: July 1, 2019

______________________________________________________________________________________________________________________________________

Description:

The purpose of this policy is to provide direction on how the Plan handles paying for services billed on a generic revenue code that does not require a HCPCS.

Policy:

Outpatient medical claims that include revenue codes that do not require a HCPCS will be limited to 60% of charges.  This policy applies to the following revenue codes:

  • 0250-0259 (Pharmacy)
  • 0270, 0271 and 0272 (Medical/Surgical Supplies – General)
  • 0370 – 0379 (Anesthesia)
  • 0637 (Self-Administered Drug(s))

Cross Reference:

Official UB-04 Data Specifications Manual

 

Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.