Reminder: Surgical Procedures and Implants Billing Procedure Guidelines

As a reminder, in accordance with Blue Cross and Blue Shield of North Carolina (Blue Cross NC) Facility Billing reimbursement policy, linked here for Commercial and Medicare Advantage, Blue Cross NC requires implant and procedure billing to be consistent with Blue Cross NC guidelines summarized below.

Blue Cross NC has identified providers incorrectly billing device-intensive procedures requiring an implant/device without the implant/device, or oppositely, providers billing an implant/device when no  device-intensive procedure was performed. Claims for implants/devices billed without supporting procedures or device-intensive procedures billed without supporting implants/devices will be denied. If billed incorrectly and denied, providers may resubmit corrected claims to appropriately represent corresponding procedures and implants/devices.

This applies to Medicare Advantage including Experience Health, Commercial, Host and Federal Employee Program (FEP). This will not apply to IPP Home.