Coding and Reimbursement Policy Update

This applies to both Commercial and Medicaid Expansion.

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. 

To align with medical standards, BCBSND has the following coding and reimbursement policies that will be updated for Jan. 1, 2026.

• Evaluation and Management (E/M) Policy
  • Implementing logic for Jan. 1, 2026, on Commercial & Medicaid Expansion claims.
  • When billing a preventive medicine E/M and a problem-oriented E/M visit on the same day, by the same provider or a provider in the same group, the preventive visit will be reimbursed at 100%. Reimbursement for the problem-oriented E/M service will be 75% of the allowable amount.

Questions?
For additional questions contact the appropriate Provider Service Center:

• Commercial: 800-368-2312
• Medicaid Expansion: 833-777-5779