Reminder about Units Allowed for Reimbursement

Reminder about Units Allowed for Reimbursement

4/26/2016

BlueCross BlueShield of South Carolina (BlueCross) and BlueChoice® HealthPlan of South Carolina write to remind you of payment guidelines and edits for the allowance of reimbursement for only one unit for these Current Procedural Technology (CPT) codes:

  • 97010
  • 97012
  • 97014
  • 97018
  • 97022
  • 97024
  • 97028

BlueCross and BlueChoice® will increase efforts to monitor and ensure compliance with this payment guideline and edit. This reimbursement allowance is consistent with the Centers for Medicare and Medicaid Services (CMS) handling of these codes as well as the American Medical Association’s CPT definition where each code represents the “application of a modality to one or more areas.”

For questions about this bulletin, please contact Provider Relations and Education by emailing provider.education@bcbssc.com or by calling 800-288-2227 ext. 43740.

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.