Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Medical Services)
Oral Medication When submitting oral drugs for your Blue Cross patients, use the
procedure/service codes in your HCPCS manual. HCPCS includes
many codes for oral medications and injections that are commonly
dispensed in physicians’ offices.
Non-Physician Health
Care Practitioners
11-40
Use J8499 (prescription drug, oral, nonchemotherapeutic, NOS)
only in limited situations such as after-hours emergency visits,
house calls, or in rural areas where access to a community
pharmacy is limited. Drug name, dosage, and NDC must be
included on each claim.
Benefits cannot be extended for drug samples provided by
pharmaceutical companies.
If the service is rendered by a non-physician healthcare
practitioner that we credential, and/or verify licensure and are
issued individual provider numbers, that practitioner must submit
the services under the individual provider number that Blue Cross
has issued to him or her or NPI.
Some practitioners who are not credentialed or issued individual
provider numbers or NPIs (such as LPN, RN, dietitian), work
under the supervision of a physician. The services must be
submitted under the supervising physician’s provider number/NPI.
The -U7 modifier must be submitted with the procedure/service to
indicate these services. This includes those clinics with a
pharmacist on staff. Services would be billed under the supervising
MD with the -U7 modifier.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/20/12)