BCCHPSM Billing Update for Manually Priced Durable Medical Equipment (DME) Devices (B4160 and B4161)

March 30, 2022

Based on the Healthcare Common Procedure Coding System (HCPCS)  manual narrative description of billing specification for HCPCS codes B4160 and B4161, every 100 calories of formula dispensed should be reported as 1 unit for both services. 

On claims you submit for our Blue Cross Community Health PlansSM (BCCHP) members, Blue Cross and Blue Shield of Illinois will now require that you report the number of total calories dispensed via pricing invoice, as both services are manually priced services. 

The pricing invoice should contain the following data when billing for B4160 and B4161: 

  • Member name
  • Date of service
  • Item name, description and HCPCS code
  • Number of units provided
  • Number of calories per unit and calories dispensed
  • Item wholesale price/manufacturer suggested retail price (MSRP)

Claims received with a manually priced item listed not accompanied with an appropriate pricing invoice will result in denial with reason code  heh (resubmit with required invoice).

If you have any questions or need more information, call Customer Service at 855-653-8126 or email your assigned Provider Network Consultant.