Provider Payment Policies

By accessing these policies, I acknowledge the following:

Blue Cross and Blue Shield of Vermont’s payment policies:

  • Serve as a reference to assist providers and facilities in submitting accurate claims.
  • Outline the basis for reimbursement for covered services.
  • Apply to services rendered by participating providers.
  • Are subject to changes in coding rules and guidelines, such as those established by CPT and HCPCS; there may be instances where coding changes are applied before the policies are amended.
  • May be revised from time to time based on state or federal requirements or changes to provider contracts.

BCBSVT payment policies do NOT:

  • Provide billing or coding advice.
  • Guarantee or determine benefits.
  • Control in the event of a conflict with member contracts, provider contracts, medical policies, or claim edits.
  • Dictate how other Blue Plans set allowances for care rendered by non-participating providers.
  • Constitute medical advice.

Permanent Payment Policy Name

Acupuncture    CPP_02

ClaimsXten-Select Edits    CPP_32

Frequency of Supplies (Diabetic and CPAP BIPAP)    CPP_33

Global Maternity Obstetric Package    CPP_16

Home Births     CPP_18

Home Infusion Therapy    CPP_14

Hub and Spoke System for Opioid Addiction Treatment     CPP_05

Inpatient Hospital Room and Board, Routine Services, Supplies, and Equipment    CPP_08

Modifier 22    CPP_06

Modifier 52    CPP_22

Multiple Procedure Payment Reduction-Diagnostic Imaging Procedures    CPP_09

Never Events and Hospital-Acquired Conditions    CPP_23

Observation Services     CPP_07

Operating and Recovery Room Services and Supplies     CPP_15

Preventable Readmissions (30-day readmission)     CPP_21

Provider Audit, Sampling and Extrapolation, and Re-Audit Process    CPP_19

Provider-Based Billing    CPP_11

Robotic and Computer Assisted Surgery    CPP_04

Telemedicine    CPP_03

Urgent Care Clinics    CPP_12

Use of Non-Participating Providers    CPP_20


Temporary/Emergency Policies
 

In effect until August 31, 2021

Applied Behavior Analysis (ABA) Services by Telemedicine or Telephone     CPP_29

Intensive Outpatient Therapy Services and Psychotherapy (Crisis and Group) Services by Telemedicine or Telephone     CPP_28

Physical Therapy, Occupational Therapy, and Speech Therapy     CPP_27

Preventive Medicine     CPP_26
 

In effect until December 31, 2021

Telephone Only     CPP_24

Telephone Triage    CPP_25
 

In effect until March 31, 2021

Waiver of Cost Share for COVID-19-Acute Outpatient Treatment    CPP_31

Waiver of Cost Share for COVID-19-Related Testing, Diagnosis, and Inpatient Treatment    CPP_30