Empire BlueCross BlueShield is about to implement a new reimbursement policy ‘Place of Service-Facility’ that will be effective on or after October 1, 2022. This policy is marked as Material Adverse Change (MAC).
This policy is applicable for any office, building, medical office building or clinic that is owned by a hospital or an institutional provider but not the primary structure of the hospital or institutional provider.
E/M services as well as other professional services must be billed on a CMS-1500 claim form. This is not reimbursable when billed on a UB-04 claim form.
Besides, professional services bills under revenue code (when billed in an outpatient setting) 960-983 as well as preventive counselling CPT codes 99406-99409, 99411 and 99412 are not reimbursable if submitted on a UB-04 form.
Source:
https://providernews.empireblue.com
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