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March 2013

Changes to hospital outpatient services reimbursement delayed

Since July 2012, BCBSM has published several articles about reporting of services for the Hospital Outpatient Pricing Strategy II (HOPS II) project effective April 1, 2013. While these reporting guidelines should still be applied effective
April 1, 2013, BCBSM’s payment for the services will continue on the current methodology and not be converted to a fee basis until Oct. 1, 2013.

Two important exceptions to reporting services, however, are for physical therapy, occupational therapy and speech therapy services and for emergency and trauma services.

  • Hospital outpatient – Claims should continue to be reported as they are today, using only revenue codes 0421, 0424, 0431, 0434, 0441 and 0444. Value code 80 should still be reported and series billing rules will also apply.
  • Emergency room and trauma E&M services will continue to bundle with surgical services on the claim as they do today.
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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
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