Upgrades for BCBSTN

Upgrades for BCBSTN

Bonni Wilke

6/15/2022

Hello everyone,

I'm not extremely familiar with charging patients an upgrade fee for an item when the item costs us close to what the reimbursement fee schedule is.

I've looked online at the BCBSTN provider manual, and I do still have a couple questions that I'm hoping someone out there can help me with.

The manual provides the Acknowledgment of Financial Responsibility form the patient to sign. It goes to say, Use one (1) line for each upgrade or deluxe item/service and All upgraded or deluxe services should be submitted with procedure code S1001 and the cost of the upgrade or deluxe item..

Here is the scenario, the service we're providing has an established procedure code and set fee schedule. When I'm submitting the claim, do I include both the established procedure code and the S1001 so the claim would have 2 line items, and one would be paid at the set fee schedule rate and the other, the S1001, would reflect the cost of what we're charging the patient for their part of the item?

I think what's making me question it is when the manual says to use one line for each upgrade, I'm assuming that means to use one S1001 per upgrade but not to omit the established HCPCS??

Does anyone have experience with a similar scenario and if so, would be willing to share how you coded it out and had success and/or the least amount of headache?

Thank you,


Bonni Wilke

Office Manager


Precision Prosthetics, Inc

1505 S Perkins Rd

Memphis, TN 38117

p. 901.682.1006

f. 901.682.5775