Name of Manual - Blue Cross and Blue Shield of Minnesota

Claims Filing
Site of Service
(continued)
Freestanding
Ambulatory Surgery
Center Billing
Place of Service Code Place of Service Name
41 Ambulance - land
42 Ambulance - air & water
51 Inpatient psychiatric facility
52 Psychiatric facility - partial
53 Community mental health
center
56 Psychiatric residential treatment
center
In order to streamline our administrative processes and comply
with regulatory requirements, Blue Cross contracts with
Freestanding Ambulatory Surgery Centers as professional
submitters and requires the following guidelines and provisions:
Use of Professional Claims Submission Formats —
Freestanding Ambulatory Surgery Center providers submit
claims utilizing a HIPAA 837P claims transaction, in
compliance with Minnesota Statute 62J.52. Use national place
of service code 24.
Fee Schedule Based Payment Methodology – APC weights
were used to create fee schedule allowances (Allowance=APC
weight x conversion factor) for each procedure code, as
appropriate.
Recognition of Multiple Surgeries and Bilateral
Procedures – For multiple surgeries, the procedure with the
highest allowed amount is reimbursed at 100% of the allowed
amount. Subsequent services are reimbursed at 50% of the
allowed amount. Bilateral surgeries are billed on one line with
the -50 modifier and are reimbursed at 150% of the allowed
amount.
Adjudication of Services at the Claim Line Level – Payment
is calculated at the lesser of 100% of the provider’s regular
billed charge or the Blue Cross fee schedule allowance,
implemented at a claim line/service level.
8-16 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12)