Know guidelines for trauma activation billing and reimbursement

Blue Cross Blue Shield of Michigan and Blue Care Network follow the National Uniform Billing Committee rules for billing and reimbursing trauma activation charges. Effective immediately, Blue Cross and BCN won’t reimburse providers for trauma activation charges when they’re billed outside of the NUBC guidelines on inpatient facility claims. This rule applies to all claims submitted for Blue Cross commercial and BCN commercial members.   

This reimbursement policy isn’t intended to affect patient care. Health care providers are expected to apply medical judgment when caring for all members.

Here’s how to bill trauma activation under NUBC guidelines:

• Use revenue code 068x in conjunction with FL 14, Type of Admission/Visit code 05. In the event of trauma activation, the facility must have received a prearrival notification from a prehospital caregiver, such as a paramedic or other emergency medical services provider.
• If the member wasn’t assigned a prehospital notification revenue code, 068X shouldn’t be billed. However, the member may be classified as experiencing trauma on the UB-04, using FL 14, Type of Admission/Visit code 05 when identifying the member for follow-up purposes.
• Non-designated trauma centers shouldn’t use FL 14, type 5 or 068X when billing for trauma services.

In addition to NUBC guidance for appropriately billing trauma activation, there’s also trauma activation criteria set forth by the American College of Surgeons. Apply the ACS criteria in the prehospital setting to identify trauma patients who would benefit most from the highest level of trauma activation.

The minimum criteria to activate the highest level of trauma activation is based on ACS 2022 updates to Resources for Optimal Care of the Injured Patient.** It includes one or more of the following:

• Confirmed blood pressure less than 90 mm hg at any time in adults, and age-specific hypotension in children
• Gunshot wounds to the neck, chest or abdomen
• Glasgow Coma Scale less than 9, with mechanism attributed to trauma
• Transfer patients from another hospital who require ongoing blood transfusion
• Patients intubated in the field and directly transported to a trauma center
• Patients who have respiratory compromise or need an emergent airway
• Transfer patients from another hospital with ongoing respiratory compromise (excludes patients intubated at another facility who are now stable from a respiratory standpoint)
• Patients experiencing an emergency as determined by a physician

Revenue code 068X is only permitted for reporting trauma activation charges, and trauma centers and hospitals must be licensed, designated or authorized by the state. The revenue code a facility may bill is determined by the ACS designation. See table below for details:

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.