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Reimbursement Policy Updates

NOTE** Review policies online to determine if the policy applies to both BCBSND Commercial and/or Medicaid Expansion Plans.

The below reimbursement policies will be revised. The revisions will become effective on January 1, 2023.

  • Correct Coding Guidelines – Commercial
    • Updates to verbiage and additional information regarding when it would be considered appropriate to bill an office/outpatient E/M service with a preventive E/M service.

  • Global Surgical Package
    • Updates to verbiage-replacement of all instances of “specialty” with “specialty and sub-specialty”.

  • Consultation Services
    • Removal of CPT codes 99241 and 99251.
      • These codes will be deleted due to a decision made by the American Medical Association (AMA).

  • Observation Services
    • Removal of CPT codes 99217-99220 and 99224-99226
      • These codes will be deleted due to a decision made by the American Medical Association (AMA).

  • Coding and Billing Guidelines for Emergency Department
    • Removed references to level of history and examination.
      • These references will be deleted and only the level of medical decision-making will be used when selecting the appropriate code. Added information about time not being a descriptive component for the emergency department levels of E/M services.