Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Public Programs)
C&TC Component Commonly Billed Code(s) Notes
Dental Checkups-
verbal referral
Fluoride Varnish
Application
11-4
Not billed separately, part
of the E/M
Dental services processed through Delta
Dental of Minnesota.
D1206 Billed by PCC or Public Health Nursing
Clinic and paid as part of the C&TC.
Eligible providers include:
Nurse practitioners
Nurses
Physicians
Physician Assistants
Staff under the supervision of the treating
physician
S0302 If HCPCS code S0302 is submitted on a claim for any member
other than an MHCP member, it will be denied as provider
liability. Code S0302, completed early periodic screening
diagnosis and treatment service (EPSDT) (list in addition to code
for appropriate evaluation and management service), should be
submitted only when a completed well child or child and teen
checkup is performed for an MHCP member (i.e., PMAP or
MNCare).
C&TC Referral Codes The C&TC referral codes must be submitted on C&TC claims to
inform state and county C&TC staff that a referral was made.
Follow-up assistance is provided by the state and county to help
assure follow-up care is received. The C&TC referral codes also
fulfill Minnesota’s reporting requirements to the Centers for
Medicare and Medicaid Services (CMS) for the number of
referrals made as a result of C&TC screenings.
The C&TC referral code pertains to the entire claim and must be
entered as value '01' in loop 2300, CLM12 on the 837P claim. It
documents that a complete C&TC screening was performed for
enhanced/appropriate reimbursement purposes.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (02/07/12)