Notice of Blue Cross NC Pricing Development and Maintenance Policy Updates for BETOS/CCS, 2008 Pricing Policy and Non-2008 Pricing Policy

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) would like to inform providers that we have updated the following Pricing Development and Maintenance Policies. These policies will be effective November 1, 2022:

• Pricing Development and Maintenance Policy BETOS/CCS (PDF): The initial summary paragraphs in the policy were broken into four bulleted points to provide additional clarity on when CPT/HCPCS Codes, Code Service Categories, and New Codes are updated.
• Non-2008 Pricing Development and Maintenance Policy (PDF): The initial summary paragraphs in the policy were broken into four bulleted points to provide additional clarity on when CPT/HCPCS Codes, Code Service Categories, and New Codes are updated.
• 2008 Pricing and Development Maintenance Policy (PDF): The initial summary paragraphs in the policy were broken into four bulleted points to provide additional clarity on when CPT/HCPCS Codes, Code Service Categories, and New Codes are updated.

Additionally:

• Additional Fee Determination: The last bullet was updated to match the language in the various hierarchies where it states that once a pricing source is established, it will remain that pricing source going forward. For example, if a code is based on Optum, and in 2023 CMS provides a rate, the code will continue to be priced by Optum. 
• A new Ground Ambulance section was added

Providers contracted for participation in Blue Cross NC’s provider networks for commercial health benefit plans should refer to their organization’s specific contract for participation with Blue Cross NC to review which of the pricing and development policies is applicable. 

We value your continued participation in Blue Cross NC’s provider network, and your support in providing quality, cost-effective health care services to our members and your patients. If you have any questions related to these changes, please call the Provider Blue Line℠ at 800-214-4844.