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Medically Unlikely Edits Deviations

Applies To: Commercial

Blue Cross Blue Shield of North Dakota (BCBSND) wants to inform providers of a change to the Medically Unlikely Edits Deviations reimbursement policy that will be effective 2/1/2023. This change consists of the revision of BCBSND MUE Values for codes 96137, 96139, J0878, J3475, V2520, V2521, V2522 and V2523. As well as the removal of codes 90832, 90834, 90837, 96171, 99212, 99213, 99214, J0202, J0295, J0461, J0743, J1000, J1040, J1580, J1726, J2426, J2675, J2790, J3370, J3590, J7178, J7179, J7180, J7181, J7183, J7186, J7187, J7188, J7189, J7190, J7192, J7193, J7194, J7195, J7198, J7200, J7201, J7202, J7205, J7207, J7209, J9060, J9260 and Q9966 from the list as BCBSND will be following CMS’ MUE values for these codes as of 2/1/2023.

If you have any questions regarding the change, please contact the Provider Service Center at: 1-800-368-2312.