Pricing Policy Update Effective January 1, 2024

To provide better clarity around our pricing policies Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is making the following changes effective January 1, 2024.  

Blue Cross NC has modified its pricing policy language to change from using the first published file from the Centers for Medicare and Medicaid Services (CMS) for each calendar year, to the latest published file as of January 15 of each calendar year. This allows us to include CMS updates to the published file that follows the first published file.

We have updated and corrected the Optum Coding link included on pricing policies.

• New codes established on current year Medicare for Opioid Treatment Programs Bundled Payments are determined by the latest published Medicare file as of January 15 of each calendar year and will be effective for dates of service on and after April 1.
• New codes (excluding drug codes) will be priced at 60% of charge for dates of service January 1 to March 31.  

Updated policies:

• Pricing Development and Maintenance Policy BETOS/CSS (PDF)
• Pricing Development and Maintenance Policy Opioid Treatment Facility Programs (PDF)
• Pricing Policy for Procedure / Service Codes (Applicable to All PPO, POS, and HMO Products) (PDF)

If you have any questions related to these changes, please call the Provider Blue Line℠ at 800-214-4844.