IMPORTANT NEWS: Medicare Advantage (MA) Notifications - Effective January 1, 2022

Bundled Services – HCPCS 80050 

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has historically allowed for reimbursement of HCPCS 80050, General Health Panel. As of January 1, 2022, Blue Cross NC will no longer reimburse for HCPCS 80050. To better align with Centers for Medicare & Medicaid Services, health care providers and laboratories should submit the associated HCPCS code(s) for each individual panel/test/service provided rather than the bundled code (80050). 

Non “Physician Services” – Coding Errors Identified 

Blue Cross NC continues to monitor claims to ensure correct coding rules are being followed. Blue Cross NC will apply and enforce correct coding rules where applicable. Temporary measures may have been implemented last year due to the COVID-19 pandemic. The following codes were included in these measures, however, effective January 1, 2022, Blue Cross NC will no longer provide reimbursement for professional providers when billing for the following codes:  

• 86769
• 87426
• 87635
• 87636

Please reference the most current American Medical Association (AMA) CPT or HCPCS Coding for code descriptions. 

Institutional and Professional Claims filing – Diagnosis Coding

Blue Cross NC has identified professional and institutional claims reporting a secondary diagnosis code as the primary diagnosis code. For example, “family history” is classified as a secondary diagnosis per ICD-10 CM. Primary diagnosis codes must identify the principal diagnosis for an institutional inpatient admission/stay and/or professional office visit. Effective January 1, 2022, Blue Cross NC, in accordance with ICD-10 CM guidelines, will require the principal diagnosis in the principal diagnosis field (field 67 on a UB-04 claim form and field 21-1 on a 1500 Form). Claims will be rejected if submitted with a secondary diagnosis code as the principal diagnosis.

For more information on principal diagnosis and primary diagnosis codes, please click visit the Centers for Medicare & Medicaid Services' page on the 2021 ICD-10-CM COVID-19 update. 

Taxonomy Validation

Taxonomy codes are a unique 10-character code that designates a provider’s classification and specialization. For those group practices that have an assigned taxonomy code, Blue Cross NC will require taxonomy codes at the rendering provider level be filed on all claim submissions. Blue Cross NC is asking all providers to verify the taxonomy code associated with their National Provider Identifier (NPI) and make any appropriate updates to their claim filings. Reimbursement is dependent on correct taxonomy codes, consistent with CMS.

For more information related to taxonomy codes, please visit the Centers for Medicare & Medicaid Services page on finding your taxonomy code.