Physicians/Specialists
Facilities/Hospitals
Ancillary
Publication Date: 
2019-12-16

In 2019, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) introduced a new pathology billing policy, AHS-R2169, to help lower the costs of laboratory services for our members. This policy was designed because:

  • We have a responsibility to control costs on behalf of our members.
  • Pathology performed in providers' private labs can cost up to twice the amount of anatomic pathology (AP) performed by independent labs.
  • There is great variability in the cost of AP services among providers.
  • Our members seldom get to choose their pathology provider, making them more vulnerable to higher costs.

In response to questions we received from providers, Blue Cross NC:

  • Is suspending AHS-R2169 and all related claim-editing processes.
    • We will identify all POS 11-denied claims, from October 1, 2019 – December 3, 2019, for the surgical pathology code range of 88300-88399, and will make the appropriate adjustments.
    • If you are a provider who held a claim, thank you for your patience. Pathology edits were placed on hold and backdated to the initial implementation of the policy on October 1, 2019. These claims can now be released and will process as they were before the policy was implemented.
  • Will issue a revised pathology billing policy and associated billing requirements early in 2020.  
    • We are currently reviewing all submitted questions and concerns. We'll share a comprehensive document outlining billing scenarios before re-issuing the policy in 2020.