Coding and Reimbursement Policy and Guidelines Updates

Blue Cross Blue Shield of North Dakota (BCBSND) continually develops and revises coding and reimbursement policies and resources in response to rapidly changing medical technology and updates to the coding sets. Our commitment is to update the provider community as coding and reimbursement policies and guidelines are added, adopted, and/or revised.

The following coding and reimbursement policy and/or guideline updates will become available on the website within the next 45 days. The changes below can be referenced in the updated and/or new policies and/or guidelines:

The following change applies to Medicaid Expansion only.
Correct Coding Policy - Medicaid Expansion

  • Policy title changed from Correct Coding Guidelines to Correct Coding Policy.
  • Added legal disclaimer: “All claims submitted for this policy will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.”
  • Added 76, 77 & 91 (Repeat and Duplicate Services) guidelines to the cross references section.
  • Added “possibly” to instances of “to allow” and “will allow.”
  • Changed “Revised Date:” to “Revision Effective Date:”
  • Added add-on code section and table of contents.
  • Updated table of contents and dates.

The following change and new guideline apply to Commercial only.
Correct Coding Policy - Commercial

  • Added add-on code section.
  • Updated table of contents and dates.

Medication for Opioid Use Disorder (MOUD)

  • New guideline.
  • Added new billing guidelines to help provide guidance to providers on how to bill for MOUD services.

The following changes apply to Commercial and Medicaid Expansion.
Psychiatric and Substance Use Services Guidelines

  • Added clarification regarding behavioral health services outside of this policy need to be billed on the CMS-1500 claim form.   

Qualified Healthcare Provider’s Allowed Amount Reductions

  • Added information regarding allowing HCPCS code H2019 at 100% of Prospective Payment System (PPS) for Licensed Addiction Counselor (LAC), Licensed Clinical Social Worker (LCSW), Licensed Professional Clinical Counselor (LPCC), Licensed Master Social Worker (LMSW) and Licensed Professional Counselor (LPC). (backdated to May 1, 2024)
  • Added clarification regarding items that are allowed at 100% of PPS for Psychologist.
  • Added blood and blood products as allowed at 100% of PPS for Clinical Nurse Specialist (CNS), Nurse Midwife, Nurse Practitioner (NP), Physician Assistant (PA) and Local Public Health Units.
  • Added Medication for Opioid Use Disorder (MOUD) HCPCS codes (H0020 & H2010) to allow at 100% of PPS for CNS, NP, PA, LAC, LCSW, LPCC, LMSW and LPC.

The following guideline is new for Commercial and Medicaid Expansion.
Home Infusion Therapy Services

  • New guideline.
    • Replacing previously published Home Infusion Billing Guidelines, which were sent to providers every year with their fee schedules.
    • Now published as a new guideline instead of being sent with fee schedules.

Contact the Provider Services department by calling the number on the back of the member ID card.