Effective for dates of service on or after January 1, 2020, Empire BlueCross BlueShield (“Empire”) will consider outpatient claims for NYSHIP members receiving hyperbaric oxygen therapy, whether done as a sole service or in conjunction with another outpatient service.

 

For dates of service prior to January 1, 2020, Empire considered hyperbaric oxygen therapy claims only if billed in conjunction with a qualifying service such as emergency care or surgery service and United Health Care (UHC), NYSHIP’s medical benefit administrator, considered the claims when it was the sole service or billed without a qualifying service.  

 

This only applies to hyperbaric oxygen claims in the outpatient hospital setting.  All claims will still be subject to standard medical necessity guidelines.



Featured In:
January 2020 Empire Provider News