Blue Cross Newsletter
 

 

June 19, 2007

 

 

DC-07-11
To: All Blue Cross Contracting End Stage Renal Disease Centers
From: Donna Bartee, Communications Representative
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
Subject:

EPO – Value Code 68


In the past, BCBSKS instructed ESRD providers that when billing charges for EPO you needed to also report Value Code 68 with the number of units of EPO administered.  BCBSKS used the value code information to calculate the EPO allowance and if it wasn't included, we returned the claim to you. 

Good news.  Starting with service dates of June 1, 2007, BCBSKS will no longer use the value code information to calculate the EPO allowance. The allowance will be calculated based on the number of units reported on the EPO charge line (revenue code 0634 and 0635).  Units reported should reflect the definition of the HCPCS code and be rounded to the nearest whole unit. Do not use a decimal.

Unit examples:

  • Q4081 – injection, epoetin alfa, 100 units (for ESRD on dialysis)
    • 49,000 = 490 units
  • J0886 – injection, epoetin alfa, 1000 units (for ESRD on dialysis)
    • 49,000 = 49 units

The BCBSKS claims processing system is currently editing dialysis claims for the presence of value code 68 however this requirement will be removed in the near future.

The BCBSKS Institutional Provider Manual will be updated to reflect this billing change.

drb