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(Effective January 1, 2004)
Application of Policy
This policy is applicable to all providers participating in Blue Cross & Blue Shield of Mississippi Office Facility Program (includes Single Specialty Facilities).
These claims filing requirements are applicable to all lines of business, including Local Underwritten Business, self-funded groups, State & School Employees' Health Insurance Plan, Children's Health Insurance Program (CHIP), Federal Employee Program (FEP), Medicare Supplement contracts and out-of-state Blue Cross and Blue Shield subscribers (BlueCard).
Blue Cross & Blue Shield of Mississippi (BCBSMS) requires that Office Facility claims be filed on a HCFA-1500 form. The claim should be filed using the Office Facility provider identification number that you were assigned. No professional services should be filed on the same claim form as the Office Facility services.
BCBSMS requires the use of modifier -SG (ambulatory surgical center facility service) when filing Office Facility services. Modifier -SG should be appended to the primary surgical procedure, "add-on" procedures, "modifier -51 exempt" procedures, and any radiological procedures approved for coverage. A comprehensive list of "add-on"; and "modifier -51 exempt" procedures can be found in Appendix D and E in the back of the CPT manual. Modifier -51 or -50 should be appended to multiple or bilateral procedures, respectively. These services should be filed with place of treatment code 24 (ambulatory surgical center).
To assist your staff in coding claims, please find below examples of various coding scenarios.
POLICY GUIDELINESThe coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
POLICY HISTORY1/2004: Policy developed