Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Medical Services)
Practitioners that
are NOT Credentialed
by Blue Cross But Are
Issued Individual
Provider Number/NPIs
Counseling and/or Risk
Factor Reduction
Room or Machine Set-
Up Charges
Although the following practitioner types do not go through the
credentialing process, they do require an individual provider
number or NPI for claims submission.
Audiologist
Certified Registered Nurse Anesthetist (CRNA)
Licensed Assoc. Counselor (LAC)
Lic. Assoc. Marriage & Family Therapist (LAMFT)
Licensed Psychological Practitioner (LPP)
Occupational Therapist (OT)
Physician Therapist (PT)
Registered Nurse First Assist (RNFA)
Resident
Social Worker (Levels: LISW, LGSW, LSW,
LMSW, CSW, LSW, LMSW, CISW, CASW)
Speech and Language Therapist
Individual preventive medicine counseling (codes 99401-99404)
are reimbursed per contract benefits. Group preventive medicine
counseling (codes 99411-99412) may be covered under the Patient
Protection and Affordable Care Act (PPACA) otherwise known as
health care reform (HCR).
Room or machine set-up charges are considered to be an integral
part of the procedure/service being done. Do not submit separately
for these services.
Supplies in the Office Supplies in the clinic setting are generally included or part of the
procedure or service. Codes 99070, A4649 and A4550 will be
denied. Other supplies, such as Betadine or alcohol wipes, will
also be denied. Generally, supplies are only allowed separately in
conjunction with approved home health care.
Adjunct CPT Codes Adjunct CPT codes 99024-99060 are designed for the provider to
report special circumstances under which a basic procedure/service
is performed.
Care Plan Oversight
Services
11-42
Blue Cross does not consider these or provider inconvenience fees
as reimbursable services and they are denied as a provider liability.
Care plan oversight services codes 99374-99380 are not
reimbursed by Blue Cross as a separate service from the evaluation
and management codes and will deny as provider liability.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/20/12)