IMPORTANT NEWS: Medicare Advantage Notifications Effective January 1, 2022

Dec. 27, 2021 Update: This communication has been reposted to update outdated information. The communication was originally posted on October 29, 2021. 

Non “Physician Services” – Coding Errors Identified  

Blue Cross and Blue Shield of North Carolina (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 apply best coding practices using the most current American Medical Association (AMA) CPT or HCPCS Coding when billing for the following codes:   

• 86328 
• 86408 
• 86409 
• 86413 
• 86769 
• 87426 
• 87428 
• 87635 
• 87636 
• 87637 
• 87811 

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

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 requests that 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. 

Find more information related to taxonomy codes on cms.gov.