June 25, 2025
Coding and Compensation Policies describe payment rules and methodologies for Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System and ICD-10-CM coding for claims submitted as covered services. This information is a resource for our payment policies. It’s not intended to address all reimbursement-related issues. We regularly add and modify coding and compensation policy positions as part of our ongoing policy review process.
The following policies were updated:
- Non-Reimbursable Experimental, Investigational and/or Unproven Services Compensation Policy- Non-Reimbursable EIU Services Denied Codes, effective Sept. 15, 2025
- Chiropractic Services, effective, June 20, 2025
- Outpatient Services Prior to an Inpatient Admission, effective, June 20, 2025
- Preventive Services Policy, effective, July 1, 2025
- Outpatient Facility Service(s) Overlapping During an Inpatient Stay Comp Policy, effective June 20, 2025
- RBRVS and Anesthesia Conversion Factors Compensation Policy, effective June 1, 2025
- Hospice Compensation Policy, effective June 2, 2025
For more details, refer to the revised policies in Availity® Essentials through the Plan Documents Viewer application. You can access the application in Payer Spaces for Blue Cross and Blue Shield of Montana.
CPT copyright 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
Coding and Compensation Policies are based on health care professionals’ and industry standard guidelines. The coding and compensation guidelines are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.
The information provided does not constitute coding or legal advice. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment, and to submit claims using the most appropriate code(s) based upon the medical record documentation, coding guidelines and reference materials.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.