Reimbursement Policy Update: Non-Physician Providers, Evaluation and Management Services

Effective June 1, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is updating its Evaluation and Management (E&M) Services reimbursement policy.

For non-physician providers, E&M services (99202-99499) are only eligible for reimbursement when the rendering provider is an advanced practice registered nurse (nurse practitioner, clinical nurse specialist, certified nurse midwife, or certified registered nurse anesthetist) or physician assistant. Other non-physician provider specialties, detailed within the policy, are encouraged to follow existing coding guidelines when billing for E&M services within their scope of practice. Please see the related policy notification for more information. 

Blue Cross NC is implementing this change to support reimbursement within the appropriate scope of practice. For example, dentists, excluding oral surgeons, performing E&M services would utilize the appropriate dental evaluation code instead of an E&M, nutritionists would utilize the appropriate medicine code range for nutritional assessments and/or counseling, or pediatric developmental behavioral health specialties performing assessments and evaluations may more accurately code their services as a developmental test or behavioral assessment instead of an E&M.

This aligns with Blue Cross NC’s mission to make healthcare more affordable for all.

This change will apply to Commercial, Inter-Plan Program (IPP) Host, and Federal Employee Program (FEP). CMS non-physician provider E&M guidelines are already applicable to Medicare Advantage.