Therapy E&M Reimbursement Update

Effective Jul. 26, 2022, Blue Cross and Blue Shield of North Carolina will no longer reimburse physical, occupational, and speech therapy providers for office and outpatient problem visits and consultations (CPT® 99202-99215 and 99241-99245). Evaluative services should be submitted using the appropriate therapy evaluation codes, such as 97161-97164, 97165-97168, or 92521-92524. 

For more information, please refer to our Evaluation and Management Services policy for Commercial (PDF) and for Medicare (PDF). 

These changes will apply to all Blue Medicare and commercial fully-insured under 65 members, State Health Plan, Administrative Services Only (ASO) and Blue Card Host members.