Blue Cross of Idaho Logo

Express Sign-on

Thank you for registering with Blue Cross of Idaho

If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

PAP 277

Implantable Device L8699 or Other Unspecified Implantable Devices Billed by ASC


Provider Administrative Policy

Section
Claims Submission
Policy Date
November 2012
Status/Date
New/November 2012
Provider Type(s)
Ambulatory Surgery Centers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Implantable Device L8699 or Other Unspecified Implantable Devices Billed by ASC

Some services performed in an ambulatory surgery center (ASC) setting may require the use of surgical implants and implantable devices that are not individually priced on the fee schedule. Implants and implantable devices are defined as medical material(s) inserted into the body, including living, inert, biological material, grafts, plates, screws, or fixation devices, used to correct, protect, or stabilize a deformity where the majority of the product is left under the skin after surgery. Materials like sutures, staples, wires, and other supplies are not separately reimbursable. Implantable drugs or biologicals as defined by CMS, as well as covered contraceptive implants, are reimbursed according to the BCI fee schedule for ASCs. Reimbursement for implants and implantable devices with an invoice cost of $100 or less is included within the procedural allowances. Implants and implantable devices with a total invoice cost greater than $100 are eligible for reimbursement at invoice cost less any discounts received by the ASC, and charges incurred for shipping and handling, and tax.

Implants and implantable devices must be billed as individual claim lines for each item. Each line item for implants and implantable devices must contain the appropriate HCPCS code with charges reflective of invoice cost. Any unspecified implantable device requires a description on the claim. If billing L8699 when no other appropriate HCPCS code is available, please ensure you submit a separate line for each implant and a description of each item. Blue Cross of Idaho will deny any claim that does not have a description. If Blue Cross of Idaho determines more appropriate coding is available even though billed under the L8699, a corrected claim may be required.

Blue Cross of Idaho may conduct monthly retrospective audits on claims including charges for implants and implantable devices as described in PAP260. We may require prior authorization on some procedures, please refer to PAP241 for prior authorization requirements.


Policy History

Date Action Reason

Search for Policies

Policy Feedback