Audience: Hospitals
Effective January 1, 2021, Excellus BlueCross BlueShield will require CPT/HCPCS codes to be billed with most revenue codes billed on UB-04 type of bill 013X. A summarized list of revenue codes that require CPT/HCPCS coding is enclosed. The full, detailed list may be found here.
This requirement aligns with all national billing coding guidelines. As of January 1, a blank CPT/HCPCS code field submitted with one of these revenue codes will result in a claim rejection and be returned to your facility.
Thank you for the quality care that you provide to our valued members. If you have questions, please contact your Provider Relations representative.
Summary List of UB-04 Revenue Codes Requiring CPT or HCPCS codes
Health Care Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) codes are required on revenue codes indicated in the grid below. Hospital Outpatient claims for services that are billed without the required HCPCS and /or CPT code(s) with the revenue code(s) will be returned to the submitter as an error message indicating that the claim HCPCS and/or CPT code(s) are missing and are required.
|
Revenue Code(s) |
Revenue Code Description |
|
0270-0279 |
Medical/Surgical Supplies and Devices |
|
0280, 0289 |
Oncology |
|
0290-0294, 0299 |
Durable Medical Equipment |
|
0300-0307, 0309 |
Laboratory |
|
0310-0314, 0319 |
Laboratory Pathological |
|
0320-0324, 0329 |
Radiology - Diagnostic |
|
0330-0333, 0335 |
Radiology - Therapeutic |
|
0340-0344, 0349 |
Nuclear Medicine |
|
0350-0352, 0359 |
CT Scan |
|
0360-0362, 0367, 0369 |
Operating Room Services |
|
0370-0372, 0374, 0379 |
Anesthesia |
|
0380-0387, 0389 |
Blood |
|
0390-0392, 0399 |
Blood Storage & Processing |
|
0400-0404, 0409 |
Other Imaging Services |
|
0410, 0412, 0413, 0419 |
Respiratory Services |
|
0420-0424, 0429 |
Physical Therapy |
|
0430-0434, 0439 |
Occupational Therapy |
|
0440-0444, 0449 |
Speech-Language Pathology |
|
0450, 0459 |
Emergency Room |
|
0451 |
EMTALA Emergency Medical Screening Services |
|
0452 |
ER beyond EMTALA screening |
|
0456 |
Urgent Care |
|
0460, 0469 |
Pulmonary Function |
|
0470-0472, 0479 |
Audiology |
|
0480-0483, 0489 |
Cardiology |
|
0490, 0499 |
Ambulatory Surgical Care |
|
0500, 0509 |
Outpatient Services |
|
0510-0517, 0519 |
Clinic |
|
0520-0523 |
Free-Standing Clinic |
|
0524-0525 |
RHC/FQHC Prac Visit |
|
0526 |
Urgent Care Clinic |
|
0527 |
RHC/FQHC VN Service to Members Home in Home Hlth Shortage Area |
|
0528 |
RHC/FQHC Prac Visit to other non RHC/FQHC site |
|
0529 |
Free-Standing Clinic - Other Free-Standing Clinic |
|
0530-0531, 0539 |
Osteopathic Services |
|
0560 |
Medical Social Services |
|
0561 |
Medical Social Services - Visit Charge |
|
0562 |
Medical Social Services - Hourly Charge |
|
0569 |
Medical Social Services - Other Medical Social Services |
|
Revenue Code(s) |
Revenue Code Description |
|
0610-0616, 0618, 0619 |
MRI |
|
0621 |
Med/Surg Supplies - Supplies Incident to Radiology |
|
0622 |
Med/Surg Supplies - Incident to Other Diagnostic Services |
|
0623 |
Surgical dressings |
|
0624 |
FDA investigational devices |
|
0631-0637 |
Drugs Requiring Specific Identification |
|
0681-0684, 0689 |
Trauma Level I – Level IV, Other |
|
0700 |
Cast Room |
|
0710 |
Recovery Room |
|
0720-0724, 0729 |
Labor Room/Delivery |
|
0730-0732, 0739 |
EKG/ECG (Electrocardiogram) |
|
0740 |
EEG (Electroencephalogram) |
|
0750 |
Gastrointestinal Services |
|
0760-0762, 0769 |
Treatment/Observation Room |
|
0770 |
Preventive Care Services – General |
|
0771 |
Vaccine administration |
|
0780 |
Telemedicine – General |
|
0790 |
Extra-corporeal shock wave therapy |
|
0810-0814, 0819 |
Organ Acquisition |
|
0820-08259, 0829 |
Hemodialysis – Outpatient or Home |
|
0830-0835, 0839 |
Peritoneal Dialysis – Outpatient or Home |
|
0840-0845, 0849 |
Continuous Ambulatory Peritoneal Dialysis (CAPD) |
|
0850-0855, 0859 |
Continuous Cycling Peritoneal Dialysis (CCPD) |
|
0860-0861 |
Magnetoencephalography (MEG) |
|
0871-0874 |
Cellular Immunotherapy and Gene Therapy |
|
0880-0882, 0889 |
Miscellaneous Dialysis |
|
0920-0925, 0929 |
Other Diagnostic Services |
|
0940-0949 |
Other Therapeutic Services |
|
0950-0952 |
Other Therapeutic Services |
|
0960, 0962-0964, 0969, 0971- 0975, 0977-0978, 0981 |
Professional Fees |
|
0982-0989 |
Professional Fees - Outpatient Services |
|
2100-2106, 2109 |
Alternate Therapy Services |
Version 08-17-2020
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