Blue Cross and Blue Shield of North Carolina (Blue Cross NC) continues to monitor claims to ensure that claims are being coded properly. Treatment room (revenue code 0761) is not appropriate to report office or clinic-based Evaluation and Management services (99202-99215, 99241-99245, G0463). Per the National Uniform Billing Committee: Data Specifications Manual (UB-04 Manual), revenue code 0761 should only be used when a specific procedure has been performed or treatment has been rendered.
Providers should ensure that they do not improperly report revenue code 0761 to represent Evaluation and Management services.
These changes apply to the following lines of business: Administrative Services Only (ASO), fully insured membership, Blue Card IPP Host and the State Health Plan (SHP).