Reimbursement Policies

Blue Medicare

Reimbursement Policy Update for January 1, 2023

Medicare Reimbursement Policy	Reason for Update
Add-On Codes	Routine Policy Review. Minor revisions only.
Anesthesia, Professional and Facility	Routine Policy Review. Minor revisions only.
Bundling Guidelines	Routine Policy Review. Removed Care Management Section.
Co-Surgeon, Assistant Surgeon, and Assistant-at-Surgery Guidelines	Routine Policy Review. Minor revisions only.
Consistency Guidelines	Routine Policy Review. Minor revisions only.
Diagnosis Validity & Code Guidelines	Routine Policy Review. Minor revisions only.
Evaluation and Management Services	Routine policy review. Minor revisions only.
Facility Billing Guidelines	Routine Policy Review. Minor revisions only.
Global Surgery	Routine Policy Review. Minor revisions only.
Immunization Guidelines	Routine Policy Review. Minor revisions only.
Inpatient Readmission	Routine Policy Review. Minor revisions only.
Maximum Units of Service	Routine Policy Review. Minor revisions only.
Modifier Guidelines	Routine Policy Review. Minor revisions only.
Multiple Procedure Payment Reduction Guidelines	Routine Policy Review. Minor revisions only.
NCCI Editing	Routine Policy Review. Minor revisions only.
NDC	Routine Policy Review. Minor revisions only.
Observation	Routine Policy Review. Minor revisions only.
Once in a Lifetime	Routine Policy Review. Minor revisions only.
Outpatient Code Editor (OCE) Edits	Routine Policy Review. Minor revisions only.
Partial Hospitalization and Intensive Outpatient Programs	Routine Policy Review. Minor revisions only.
Place of Service	Language added to clarify DME billing requirement for POS. Medical Director approved.
Preadmission and Preoperative Services	Routine Policy Review. Minor revisions only.
Pricing and Adjudication Principles	Routine Policy Review. Minor revisions only.
Revenue Codes Requiring Procedure Codes, Facility	Routine Policy Review. Minor revisions only.
Split Surgical Package	Routine Policy Review. Minor revisions only.
Status Codes	Routine Policy Review. Minor revisions only.
Supply and Equipment Reimbursement	Routine Policy Review. Minor revisions only.
Telehealth	New policy developed. Medical Director approved.
Unplanned Return to Surgery	New policy developed. Blue Cross NC will reduce reimbursement for services filed with modifier 78.