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Reimbursement Policy Update for January 1, 2023
| Medicare Reimbursement Policy | Reason for Update |
|---|---|
| Routine Policy Review. Minor revisions only. | |
| Anesthesia, Professional and Facility | Routine Policy Review. Minor revisions only. |
| Bundling Guidelines | Routine Policy Review. Removed Care Management Section. |
| Co-Surgeon, Assistant Surgeon, and Assistant-at-Surgery Guidelines | Routine Policy Review. Minor revisions only. |
| Consistency Guidelines | Routine Policy Review. Minor revisions only. |
| Diagnosis Validity & Code Guidelines | Routine Policy Review. Minor revisions only. |
| Evaluation and Management Services | Routine policy review. Minor revisions only. |
| Facility Billing Guidelines | Routine Policy Review. Minor revisions only. |
| Global Surgery | Routine Policy Review. Minor revisions only. |
| Immunization Guidelines | Routine Policy Review. Minor revisions only. |
| Routine Policy Review. Minor revisions only. | |
| Maximum Units of Service | Routine Policy Review. Minor revisions only. |
| Modifier Guidelines | Routine Policy Review. Minor revisions only. |
| Multiple Procedure Payment Reduction Guidelines | Routine Policy Review. Minor revisions only. |
| NCCI Editing | Routine Policy Review. Minor revisions only. |
| NDC | Routine Policy Review. Minor revisions only. |
| Observation | Routine Policy Review. Minor revisions only. |
| Once in a Lifetime | Routine Policy Review. Minor revisions only. |
| Outpatient Code Editor (OCE) Edits | Routine Policy Review. Minor revisions only. |
| Partial Hospitalization and Intensive Outpatient Programs | Routine Policy Review. Minor revisions only. |
| Place of Service | Language added to clarify DME billing requirement for POS. Medical Director approved. |
| Preadmission and Preoperative Services | Routine Policy Review. Minor revisions only. |
| Pricing and Adjudication Principles | Routine Policy Review. Minor revisions only. |
| Revenue Codes Requiring Procedure Codes, Facility | Routine Policy Review. Minor revisions only. |
| Split Surgical Package | Routine Policy Review. Minor revisions only. |
| Status Codes | Routine Policy Review. Minor revisions only. |
| Supply and Equipment Reimbursement | Routine Policy Review. Minor revisions only. |
| New policy developed. Medical Director approved. | |
| New policy developed. Blue Cross NC will reduce reimbursement for services filed with modifier 78. |
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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