Policy Statement
Our health plan will not reimburse or permit a provider or other qualified health-care professional to retain reimbursement for services that are not intended to be performed by a physician in a facility setting such as a hospital outpatient or emergency department. These physician charges will be denied as a provider write-off.
Ambulatory Surgical Centers (ASC), with a provider type of BZ, are excluded from this policy.
Examples of services defined as injection, infusion therapy and chemotherapy infusion that are not reportable by physicians and other qualified healthcare professionals for services provided in a facility setting include, but are not limited to:
- Injection services codes: 96372 - 96377, and 96379.
- Infusion therapy services codes: 96360, 96361, and 96365 - 96371.
- Chemotherapy infusion services codes: 96401 - 96413.
The American Medical Association (AMA) Current Procedural Terminology (CPT) Therapeutic, Prophylactic, and Diagnostic Injections and Infusions section guidelines states: “These codes are not intended to be reported by the physician or other qualified health care professional in the facility setting”.
Facility Place of Service codes are:
