Important Update to Enhanced Ambulatory Patient Grouping (EAPG)

Blue Cross Blue Shield of North Dakota (BCBSND) is notifying our EAPG provider community of important changes.

The Enhanced Ambulatory Patient Grouping (EAPG) classification methodology is used to describe the amount and type of resources utilized during a wide range of ambulatory visits. BCBSND uses the EAPG system for claims submitted for hospital outpatients, ambulatory surgical centers, partial psychiatric and partial substance use services.

Behavioral Health EAPG Payment Changes
Effective Jan. 1, 2026, the following Behavioral Health EAPGs were assigned a weight of 0 and will no longer be reimbursed:

These changes align with BCBSND Psychiatric and Substance Use Services Guidelines, which indicate that services not addressed within that policy must be billed using the CMS‑1500 claim form.

Fee schedule information
We will only update EAPG fee schedules to reflect this change moving forward.

Recoupment
Providers that were paid incorrectly may be subject to payment recoupment for dates of service on/after Jan.1, 2026.

Additional Resources
For more information about EAPG classifications and billing guidelines, please refer to:

• Enhanced Ambulatory Patient Grouping information on our website
• The Commercial Provider Manual 
• The Medicaid Expansion Provider Manual

Questions?
If you have questions or need assistance, please contact our Provider Contact Centers:

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