Clarification: Billing guidelines for enteral and parenteral nutrition therapy services

Health care providers must include modifier BO on all claims submitted for nutrients and supplies for Blue Cross Blue Shield of Michigan members who are fed orally.

In addition, providers should include the GA modifier on all claims, along with a GY or GZ modifier, which will acknowledge that: 

• The services are expected to be rejected.
• The member was informed and agreed to accept total responsibility.
• An Advance Notice of Member Responsibility form was signed before services were given and is on file.

If providers don’t include the GA modifier on claims appended with a GY or GZ modifier, those providers will be held responsible for the cost of the services.

Providers must present a written notice to Blue Cross members before providing medical services or supplies that are expected to be rejected. For the notice to be acceptable, a provider must:

• Complete the responsibility form in its entirety.
• Clearly identify the particular item or service that is expected to be denied.
• State the specific reason that Blue Cross will deny payment for the particular item or service.
• Indicate the estimated cost of the item or service that is associated with the denied claim and the member is responsible.

The following are the HCPCS codes for enteral and parenteral nutrition therapy services:

• B4149  
• B4150  
• B4152  
• B4153
• B4154
• B4155  
• B4158 
• B4159  
• B4160
• B4161