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.
CPT® examples of services defined as injection, infusion therapy and chemotherapy infusion that are not reportable by physicians and other qualified healthcare professionals when 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:
