Blue Cross Blue Shield Minnesota policy

Site of Service for Selected Outpatient Procedures: Outpatient Hospital and Ambulatory Surgery Center

Site of Service for Selected Outpatient Procedures: Outpatient Hospital and Ambulatory Surgery Center is a public Blue Cross Blue Shield Minnesota policy (policy XI-03, effective Mar 2, 2026). It lists 97 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

View the original policy ↗

Payer
Blue Cross Blue Shield Minnesota
Policy number
XI-03
Effective
Mar 2, 2026
Line of business
Commercial, Medicaid
Source
securecms.bluecrossmnonline.com

Codes in this policy

The CPT and HCPCS codes the policy names. A policy can name a code it excludes.

CodeOther Blue Cross Blue Shield Minnesota policies
00632Policies naming 00632
12220Policies naming 12220
16875Policies naming 16875
20777Policies naming 20777
20852Policies naming 20852
21320Policies naming 21320
22169Policies naming 22169
28005Policies naming 28005
28285Policies naming 28285
28289Policies naming 28289
28291Policies naming 28291
28292Policies naming 28292
28296Policies naming 28296
28297Policies naming 28297
28298Policies naming 28298
28299Policies naming 28299
29805Policies naming 29805
29806Policies naming 29806
29807Policies naming 29807
29819Policies naming 29819
29820Policies naming 29820
29821Policies naming 29821
29822Policies naming 29822
29823Policies naming 29823
29824Policies naming 29824
29825Policies naming 29825
29826Policies naming 29826
29827Policies naming 29827
29828Policies naming 29828
29830Policies naming 29830
29834Policies naming 29834
29835Policies naming 29835
29836Policies naming 29836
29837Policies naming 29837
29838Policies naming 29838
29840Policies naming 29840
29844Policies naming 29844
29845Policies naming 29845
29846Policies naming 29846
29847Policies naming 29847
29848Policies naming 29848
29860Policies naming 29860
29861Policies naming 29861
29862Policies naming 29862
29863Policies naming 29863
29870Policies naming 29870
29873Policies naming 29873
29874Policies naming 29874
29875Policies naming 29875
29876Policies naming 29876
29877Policies naming 29877
29879Policies naming 29879
29880Policies naming 29880
29881Policies naming 29881
29882Policies naming 29882
29883Policies naming 29883
29884Policies naming 29884
29885Policies naming 29885
29886Policies naming 29886
29887Policies naming 29887
29888Policies naming 29888
29889Policies naming 29889
29891Policies naming 29891
29892Policies naming 29892
29893Policies naming 29893
29894Policies naming 29894
29895Policies naming 29895
29897Policies naming 29897
29898Policies naming 29898
29899Policies naming 29899
29914Policies naming 29914
29915Policies naming 29915
29916Policies naming 29916
30140Policies naming 30140
30520Policies naming 30520
42545Policies naming 42545
43235Policies naming 43235
43239Policies naming 43239
43249Policies naming 43249
45378Policies naming 45378
45380Policies naming 45380
45384Policies naming 45384
45385Policies naming 45385
49505Policies naming 49505
49650Policies naming 49650
49651Policies naming 49651
57522Policies naming 57522
58353Policies naming 58353
58558Policies naming 58558
58563Policies naming 58563
58565Policies naming 58565
66984Policies naming 66984
69436Policies naming 69436
69631Policies naming 69631
74582Policies naming 74582
G0105Policies naming G0105
G0121Policies naming G0121

All Blue Cross Blue Shield Minnesota policies

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.