Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Forms and Documents Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for Blue Connect Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
Back
Notification of Policy Revisions Effective January 1, 2023 (Posted June 30, 2022) June 30, 2022
Medical PolicyRevision
Private Duty Nursing Services 

Description updated. When Private Duty Nursing services are covered updated to reflect: “The services are ordered by a licensed physician (MD, doctor of medicine; or DO, doctor of osteopathic medicine) as part of a treatment plan for a covered medical condition, and The attending physician must approve a written treatment plan with short and long term goals specified, and The services provided are reasonable and necessary for care of a patient’s illness or injury or particular medical needs, and are within the accepted standards of nursing practice, and Provide care needed by the member when their condition stabilized.and The services are performed by a licensed nurse (i.e., Registered Nurse, RN; or Licensed Practical Nurse, LPN), and The services provided are within the scope of practice of a licensed nurse (RN or LPN), and The services require the professional proficiency and skills of a licensed nurse (RN or LPN), and The services are provided in the patient’s private residence, and The patient’s condition is such that a licensed professional is required to reinforce/educate and teach the caregiver the technical as well as basic care needs of the member. The length and duration of skilled nursing services in the home is considered intermittent and temporary in nature and not intended to be provided on a permanent ongoing basis. The member’s condition requires frequent nursing assessments and changes in the plan of care with MD collaboration. The member and caregivers must accept and be engaged in the Blue Cross Blue Shield of North Carolina Case Management process.” When Private Duty Nursing Services are not covered updated to reflect: “When the conditions above are not met.The nurse providing care must not be the patient’s spouse, natural or adoptive child, parent, or sibling, grandparent or grandchild. This also includes any person with an equivalent step or in-law relationship to the patient. PDN is not considered medically necessary if a caregiver is unavailable to assume the care needs of the member. PDN is not covered if the patient is in an acute inpatient hospital, inpatient rehabilitation hospital, skilled nursing facility, intermediate care facility or a resident of a licensed residential care facility. PDN is not covered for the convenience of the member/caregiver or to allow respite/sleep for caregivers or patient’s family. PDN is not covered to allow the patient’s family or caregiver to work or go to school. The time the nurse spends traveling to and from a patient’s home is included in the cost for providing the service. It is not covered separately. Maintenance care or custodial care is not considered PDN. (See Policy Guidelines below.) PDN in the home is not covered when provided at the same time as other home healthcare nursing services. Policy Guidelines and Medical Definitions updated for clarity. Specialty Matched Consultant Advisory Panel review 2/2022. Medical Director review 5/2022. Notification given on 7/1/22 for effective date 1/1/2023.

 

 

 

 

About Us Newsroom Blog Member Forms COVID-19 Transparency in Coverage Find Care Rights & Responsibilities Policies & Best Practices Privacy Policy Website User Agreement Fraud & Abuse Technical Information Contact Us Locations Careers

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

Information in other languages: Español   中文   Tiếng Việt   한국어   Français   العَرَبِيَّة   Hmoob   ру́сский   Tagalog   ગુજરાતી   ភាសាខ្មែរ   Deutsch   हिन्दी   ລາວ   日本語

© 2025 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.