Service Codes with Relative Value of Zero

The Alliance participating providers whose contract is based on reimbursement rates calculated from either OPTUM The Essential RBRVS or OPTUM Relative Values for Physicians shall reprice at $0.00 for service codes valued at 0 (zero) on their respective contracted methodology and these services are not separately reimbursable.

Contracted participating providers whose methodology is OPTUM The Essential RBRVS shall only apply the above guideline when the service code is indicated by OPTUM as a gap code.

OPTUM Zero Valued Codes (Gap Codes)