Blue Cross and Blue Shield of Minnesota and Blue Plus (Blue Cross) has developed reimbursement policies that provide coding and reimbursement requirements for healthcare services.
Coding and reimbursement processes are subject to all terms of the Provider Service Agreement as well as changes, updates and other requirements of coding rules and guidelines. All codes are also subject to federal HIPAA rules, and in the case of medical code sets (HCPCS, CPT, ICD-10-CM), only codes valid for the date of service will be accepted. These policies are superseded by benefits and/or by state or federal requirements.
The reimbursement policies are separated by line of business (Commercial, Medicaid or Medicare). If there is not a policy for a specific line of business refer to the following sources:
- Medicaid: Refer to Minnesota Health Care Program (MHCP) Provider Manual for guidance. NOTE: Blue Cross Medicaid Reimbursement Policies became effective 1/1/2024.
- Medicare: Refer to Centers for Medicare & Medicaid Services (CMS) for guidance.
| Commercial |
| Medicaid |
| Medicare |
| Commercial |
| Medicaid |
| Medicare |