01Previously due January 1, 2021 (date passed; verify current applicability): Phase two of the readmissions policy, which extends the period from 15 to 30 days, is delayed until this date, and Blue Cross will communicate details on phase two before implementation.
02Already effective since September 1, 2019 (phase one, still in effect): Readmissions to the same or an affiliated facility for the same condition, similar condition or a complication of the original condition within 15 days of discharge will not be reimbursed, the first admission payment covers full reimbursement for treatment of the condition and related complications, and providers cannot bill members for services recouped as a result of this policy.
03Check current applicability of these readmission rules before billing, and review the full policy in the Member Provider Procedure and Policies Manual on iLinkBlue under Resources.
04Billing team: for single-dose vial waste, report the wasted amount on a separate claim line with modifier JW.
05Record in the patient record the amount administered with the date and time, and the amount discarded with the reason for the wastage.
06Do not bill separately for waste that would result in overpayment, and use the most cost-effective vial or combination of vials for the medically appropriate dose.
07Already effective for dates of service on and after September 1, 2020: Drug reimbursement schedule codes were updated.
08Professional providers can enter 09/01/2020 in the Select a Date field of the Professional Provider Allowable Charges Search application, and facility providers can use the Facility Allowables link.
09The outpatient code range list added code 87635 effective April 1, 2020 and codes J0223, J9177, G2170 and G2171 effective July 1, 2020, and the source states these changes do not affect existing codes and allowables.
10Place of service 19 is not valid for Blue Cross claims and should not be used to bill any services.
11Use place of service 11 for services in the office setting, billed on the CMS-1500 claim form, and place of service 22 for services in the outpatient hospital setting.
12Blue Cross does not recognize provider-based billing.