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.

The following coding and reimbursement policies will have updates for Jan.1, 2025:

• Telehealth Services (Reimbursement Policy)
  • Verbiage was added to the distant site telehealth services (Note section) stating 95 modifier is required on claims received prior to Jan. 1, 2025.
• Evaluation and Management Policy
  • Clarification was added to the E/M and Behavioral Health section specifically for Medicaid Expansion claims.
  • Clarified the use of the AF modifier is effective for dates of service on/or after Jan. 1, 2025.
  • The consideration for reimbursement of prolonged services codes was included as part of the update based on the provider’s fee schedule.

Questions?
For additional information questions contact the appropriate Provider Service Center.