Medical Care and Associated Services

Policy ID: NDRP-GC-018
Section: Medical Care and Associated Services
Effective Date: July 01, 2018
Last Reviewed: September 05, 2019

Description:

This policy provides direction on services identified as bundled into an evaluation and management (E/M) service. The services discussed in this policy are inherent components of an E/M service.

Policy:

Routine medical care may include itemized billing. Some services cannot be separately billed when an E/M is billed on the same day or within a designated timeframe from the medical visit. CPT Guidelines must be followed when separately reporting services that are components of an E/M service. When any of the below services are reported on the same day as an E/M service (or within the designated timeframe below), payment for the below services will be included in the allowance for the E/M service.

  • 96127 – Brief emotional/behavioral assessment may not be billed on the same day as an E/M service.
  • 99172 and 99173 – Visual function screening, automated or semi-automated may not be billed on the same day as an ophthalmological service or a non-preventive E/M service.

The above list is not an all-inclusive list of services not separately billable with an E/M service. Providers must refer to National Correct Coding Guidelines and the CPT and HCPCS Coding Guidelines.

Cross Reference:

CPT Guidelines

Disclaimer

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.