ASC Billing & Reimbursement Updates

ASC Billing & Reimbursement Changes Effective 6/1/2022

Effective 6/1/2022, BCBSWY will be updating its ASC reimbursement rates and rules. Updated ASC rates can be found in the Availity portal under the BCBSWY Payer Space. Changes to our billing rules are below.

Updates regarding status indicators.

  • BCBSWY does not reimburse separately for codes that are status B or status N.
  • Codes identified as S, T, Q1 or Q2 are reimbursed subject to established multiple surgical reductions.
  • Codes identified as J1 are only payable if they have the highest maximum allowable on the claim. In that case, all other surgical procedures on the claim are not separately payable.

Updates regarding processing rules.

  • As indicated in the note on status indicators, BCBSWY will make comprehensive payments for a subset of codes. On claims for these J1 codes, BCBSWY will reimburse the highest maximum allowable among J1 codes on the claim and consider payment for all other surgical services on the claim included.
    • When determining if our allowance must be limited to a provider’s charge, BCBSWY will consider the charges and allowances for all lines on the claim, including lines on which separate payment will not be made.

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