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Enhanced Ambulatory Patient Groups (EAPG)

Blue Cross Blue Shield of North Dakota (BCBSND) has been utilizing the EAPG outpatient reimbursement system since November 2020. The EAPG classification methodology is used to explain the amount and type of resources used in a wide range of ambulatory visits. BCBSND utilizes the EAPG classification system for hospital outpatient, ambulatory surgical center, partial psychiatric and partial substance abuse claims.

BCBSND would like to extend the invitation to providers who have not transitioned to the EAPG reimbursement system the opportunity to make that change in 2022. If you are interested in learning more about the EAPG system, we have resources on our website. The Provider Manual has a section dedicated to EAPG that includes an overview, billing guidelines and information about consolidation, packaging and discounting. The Coding & Reimbursement page on the website has an EAPG Frequently Asked Questions (FAQ) document. We are also available for individual meetings to discuss the impacts of moving to the EAPG system for your organization.

If you are ready to make the change to the EAPG system, please email FeeSchedules@bcbsnd.com. We can make the switch from the hospital outpatient fee schedule to the EAPG reimbursement system effective the first of the month following receipt of the request. If you are needing more information to ensure this is the right decision for your organization, please reach out to your Provider Partner to set up a time to visit about this system and impacts to your company.