Coding and Reimbursement Policy 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 are adopted and/or revised. These updates apply to both BCBSND Commercial and Medicaid Expansion plans, unless noted otherwise.  
The following coding and reimbursement policy updates will become effective September 1, 2023:   

  • Medically Unlikely Edits (MUE) Deviations 
    • Removed the deviation for Healthcare Common Procedure Coding System (HCPCS) codes J0969, J0744, J0878, J1572 and J2543 as BCBSND will be following the Centers for Medicare and Medicaid Services (CMS) MUE value(s).  
  • Correct Coding Guidelines – Medicaid Expansion-The change applies to Medicaid Expansion only  
    • Medicaid does not allow the billing of 99358, 99359 and 99417 for prolonged Evaluation and Management (E/M) services which exceed the maximum time for a level five office/outpatient E/M visit by at least 15 minutes on the date of service. Claims processed on or after September 1, 2023, will be denied upon post pay review.