Reimbursement Policy: Observation, Facility Policy Revision

Effective, September 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will apply revisions to the reimbursement policy: Observation, Facility. 

Blue Cross NC will not allow reimbursement for observation services performed for less than eight hours (i.e., seven units or less). Less than eight hours of observation will be included in the reimbursement for other services being billed.  

Regardless of length, all observation services must be reported on a single line, and the date of service for that line is the date that observation services begin. Observation services should not be reported with a date span or on separate claim lines, even when the period of observation care spans more than one calendar day. Please see the related policy for more information.

For example, member receiving observation services Monday – Wednesday would be appropriately submitted on a single line with Monday’s date.

This change will apply to Commercial, Inter-Plan Program (IPP) Host, State Health Plan and Federal Employee Program (FEP). This policy change will bring alignment with CMS and Medicare Advantage.