Revenue Codes 025x and 063x

Section: General Coding

Effective Date: October 01, 2022

Revised Date: August 14, 2023

Last Reviewed: August 14, 2023

Applies To: Medicaid Expansion Only

Description

This policy provides direction on Blue Cross Blue Shield of North Dakota (BCBSND) requirements when billing Revenue Codes 025x or 063x.

Policy

Effective October 1, 2022, BCBSND requires the submission of a Healthcare Common Procedure Coding System (HCPCS) code and a National Drug Code (NDC) on claim lines billed with Revenue codes 025x and 063x submitted on the outpatient institutional UB-04 Claim Form. Medicaid Outpatient Hospital UB-04 claim lines billed with Revenue Code 025x or 063x will be denied if submitted without the NDC or HCPCS codes. Providers must use the Centers for Medicare & Medicaid Services (CMS) guidance and industry standards to associate the correct NDC to the corresponding HCPCS code billed on Rev Code 025x or 063x.

Limitations & Exclusions

While reimbursement is considered, payment determination is subject to, but not limited to:

Group or Individual benefit
Provider Participation Agreement
Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, payment integrity edits, and medical necessity
Mandated or legislative required criteria will always supersede.

In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.

History

Date

Updates

8/8/2022

Policy created

9/1/2022

Changed occurrences of 0250 to 025x

8/14/2023

Completed yearly review. Added payment integrity edit within limitation and exclusion statement.

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Revenue Codes 025x and 063x

Description

Policy

Limitations & Exclusions

History