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 updates will become effective on the website within the next 45 days. The changes below can be referenced in the updated policy.
Observation Services
- Added information regarding Evaluation and Management (E/M) bundling for same practitioner or more than one practitioner in the same specialty and sub-specialty in the same group.
- Updated coding scenarios and 99418 reference.
- Removed the following statement as all providers were moved to EAPG or % of charge by July 1, 2024.
“Reimbursement will be the lesser of charges or the fee schedule rate. The uniform payment rate will be based on the number of hours the patient is in an observation status. Separate rates have been established for 0-5 hours, 6-36 hours, 37-72 hours and > 72 hours. When observation care is present on a surgical claim, the observation room charges will continue to be included in the surgical roll-up methodology. Other services rendered in conjunction to Observation Care need to be billed separately.”
Medical Care and Associated Services
- Policy application was added to the policy.
- The policy was updated to remove the statement “within the designated timeframe” as the policy rules are applied to services rendered on the same day as an E/M.
- Revised date remains the same as no policy application has changed and language update is to add clarity on how BCBSND applies policy application.
Questions?
Contact the Provider Services department by calling the number on the back of the member ID card.
