NYSHIP (New York State Health Insurance Program) change in Hyperbaric Oxygen Therapy claim submissions

Effective for dates of service on or after January 1, 2020, Empire BlueCross BlueShield (“Empire”) will consider outpatient claims for NYSHIP members receiving hyperbaric oxygen therapy, whether done as a sole service or in conjunction with another outpatient service.

 

For dates of service prior to January 1, 2020, Empire considered hyperbaric oxygen therapy claims only if billed in conjunction with a qualifying service such as emergency care or surgery service and United Health Care (UHC), NYSHIP’s medical benefit administrator, considered the claims when it was the sole service or billed without a qualifying service.  

 

This only applies to hyperbaric oxygen claims in the outpatient hospital setting.  All claims will still be subject to standard medical necessity guidelines.