New billing requirements for reduced or no-cost devices

Blue Cross Blue Shield of Michigan has adopted a new medical device billing policy to align with Centers for Medicare & Medicaid Services and industry standards.

When you bill for no-cost items due to recall, replacement or free samples, follow these guidelines:

• Charges should consistently relate to the cost of the services and uniformly apply to all patients whether inpatient or outpatient.
• Medical device hospital charges must reasonably relate to the cost of the medical device.
• When a hospital receives a replacement medical device credit, the hospital must appropriately reduce charges billed to Blue Cross.
• Bill condition codes 49, 50 or 53 to identify medical devices provided by a manufacturer for reduced or no cost.
• When billing for a device received without cost or with a credit of 50% or more toward the cost of the device, also append the “FD value” with the credited amount.
• For no-cost Items, charges billed may not exceed $1.
• For reduced items, charge should reflect any reductions as a result of the credited amount, or “FD value,” from the manufacturer.

You must report these condition codes on any inpatient or outpatient institutional claim that includes a no‑cost or reduced device when meeting conditions of replacement, recall or free samples. We’ll deny claim lines for “replacement, recall or free samples” when they’re not billed according to these guidelines.