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Surgical Tray and Supplies

Provider Administrative Policy

Policy Date
July 2007
Revised/August 2008
Provider Type(s)
Ambulatory Surgery Centers   Hospitals   Physician   Podiatrists  


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.


Surgical Tray and Supplies

Claims with surgical trays and/or other supplies should include the correct revenue code.

When procedures are done in your office, please submit surgical tray charges using HCPCS code A4550. Please do not use 99070. Supply claims should include appropriate HCPCS codes. Please use the "miscellaneous" HCPCS code if you cannot find an exact code (Refer to PAP227 for instructions on how to file a claim using the miscellaneous HCPCS code).

Ambulatory Surgery Centers
Supplies and surgical trays are included in the fixed rate unless specifically addressed in your contract.

Policy History

Date Action Reason
August 2008 Revised Language clarification

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