Payment for Generic Revenue Codes

Policy ID: NDRP-Misc-002
Section: Payment for Generic Revenue Codes
Effective Date: July 01, 2019
Last Reviewed: July 01, 2019


The purpose of this policy is to provide direction on how the Plan handles paying for services billed on a generic revenue code that does not require a HCPCS.


Outpatient medical claims that include revenue codes that do not require a HCPCS will be limited to 60% of charges.  This policy applies to the following revenue codes:

  • 0250-0259 (Pharmacy)
  • 0270, 0271 and 0272 (Medical/Surgical Supplies – General)
  • 0370 – 0379 (Anesthesia)
  • 0637 (Self-Administered Drug(s))

Cross Reference:

Official UB-04 Data Specifications Manual

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.