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
Updates to Once in a Lifetime Procedure Limit Policy September 15, 2021 Medical Policy & Clinical Guidelines

Effective October 1, 2021, Blue Cross and Blue Shield North Carolina (Blue Cross NC) will limit reimbursement for each “Once in a Lifetime” procedure group to only once during a member’s lifetime according to the criteria outlined in “Once in a Lifetime” policy. Based on human anatomy, some procedures can only be performed once in a member’s lifetime. This policy describes procedures that are only possible to perform once in a member’s lifetime, therefore, only reimbursed once in a member’s lifetime. 

Each “Once in a Lifetime” procedure group will only be reimbursed once per member. “Once in a Lifetime” procedure groups may consist of one or more codes. There may be times when a “Once in a Lifetime” procedure is reported more than once, including, but not limited to, co-surgeons, team surgery, discontinued procedures, surgeries that require an assistant surgeon, laterality, or split surgical care. When it is appropriate to report a "Once in a Lifetime” code more than once, the "Once in a Lifetime” code must be reported with the appropriate modifier. 

Applicable codes are for reference only and are not all inclusive. For further information on reimbursement guidelines, please see Administrative Policies on the Blue Cross NC web site. They are listed in the Category Search on the Medical Policy search page. 

For full details, tables and guidelines on reporting and reimbursement, please see the updated “Once in a Lifetime” policy. 

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.