Updates to edits associated with implants

Effective for all claims received on or after August 1, 2022, in accordance with the Empire BlueCross BlueShield (Empire) reimbursement policy titled Implant — Facility, we will implement additional steps to review claims submitted by facilities that inappropriately include supply HCPCS codes (HCPCS codes for catheters, needles, guidewires) billed with implant revenue codes (for example, 0278).

 

Empire considers implants to be medical devices that remain in the member’s body upon discharge from the procedure. Therefore, supplies are not considered implants. Claims for supplies should be submitted with the appropriate revenue code(s). Claim lines billed inappropriately will be denied. Providers can resubmit claim for supplies using the appropriate revenue code(s).

 

If you have questions about this policy, contact your contract manager or Provider Experience representative.

 

NYBCBS-COMM-001880-22-CPN1880