Outpatient Hospital Requirements
Outlined below are generally accepted billing guidelines.
Submit one bill to Florida Blue for: All services provided on the day or within 72 hours, unless otherwise specified in your contract, of a surgical procedure being performed. This includes all charges for pre-operative testing, or ER, ER to observation, or any outpatient services continuously provided that span multiple days.
• Span date billing for services other than surgery and related services within 72 hours (e.g., span dates for serial services, such as physical therapy and chemotherapy) should not be done unless specified differently in your contract because pricing may be applied incorrectly under a cap or threshold. If span date billing is allowed under your contract, then submit actual dates of service on different lines and submit a separate line for each different CPT or HCPCS procedure code reported
• No interim or split bills.
Include charges for preoperative testing related to surgery on the same bill as the surgery, whether or not the testing was provided on the date of surgery. The span date should reflect the date of the testing through the date of the surgery. The From Date and Admission Date will be the same if pre-operative services were performed.
• Submit the date of service on each detail line.
• CPT or HCPCS codes must be reported on each detail line when the revenue code is one of the codes listed here.
• Bill physician/professional fees (0960-0989) on a CMS-1500 form only.
• Florida Blue accepts and adjudicates claims with up to 12 diagnosis codes and up to 6 procedure codes.
• Appropriate modifier codes should be reported for accurate application of Correct Coding Initiative (CCI) edits.