Return to Provider News

Coding Guideline Changes for Outpatient Hospital Facilities Effective January 1, 2021

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

 
 
Related News
New Payment Process Effective November 20, 2020

Extension of Cost-Share Waiver for In-Network Outpatient Behavioral Health Services for Essential Workers to Nov. 27

Cost-Share Update for RIT Members Related to Non-COVID-19 Telehealth Services

Member Cost-Share Waiver Update for COVID, non-COVID Telehealth Services

Category

Excellus

Claims and Billing