Update: Starting Sept. 1, BCN requires authorization for elective pediatric feeding programs (S0317)
We're updating an earlier message to clarify that providers should use S0317 with elective inpatient and outpatient pediatric feeding programs. Please use this message as your source of information about BCN's pediatric feeding program authorization requirements.
For dates of service on or after Sept. 1, 2020, services provided through pediatric feeding programs (S0317) require authorization.
This applies to:
- BCN HMOSM (commercial) members
- Elective inpatient and elective outpatient programs
Submitting authorization requests
Providers should submit authorization requests through the e-referral system. Here's what to do:
- Use S0317 when submitting requests for both inpatient and outpatient programs.
- For elective inpatient requests, do not add the length-of-stay procedure code. Use only the S0317 code when submitting authorization requests.
Claim submission for elective inpatient programs
For inpatient authorization requests that BCN approves, the length-of-stay procedure code will be added to the case so that you'll be able to bill a regular inpatient admission for reimbursement purposes. Bill the inpatient admission as you normally would. Do not bill elective inpatient pediatric feeding programs with the S0317 code.
Criteria
The criteria used to make determinations on these authorization requests are included in the Pediatric Feeding Programs medical policy (PDF), which was effective May 1, 2020.
We referred to this medical policy in the May-June 2020 (PDF) issue of BCN Provider News, in an article titled "Medical Policy Updates" (page 12).
Additional information
We're updating the following documents to reflect this new authorization requirement:
- BCN Referral and Authorization Requirements (PDF)
- Procedures codes that require authorization by BCN (PDF)
These documents are available on the Authorization Requirements & Criteria page in the BCN section of this website. Look under the "Referral and authorization information" heading.
Posted: September 2020
Line of business: Blue Care Network