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Facility emergency department evaluation and management (E&M) services reimbursement update October 15, 2025 Claims & Coding

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) assesses the intensity and / or complexity of facility interventions and resources expended based on the services rendered during the facility Emergency Department (ED) Evaluation and Management (E&M) visit. Beginning December 15, 2025, if facility resources expended during the ED encounter do not align with E&M service billed, the claim service may be subject to denial or reimbursed based on the appropriate E&M level.

Facilities may request a post-service reconsideration through the Facility Emergency Department Reconsideration Process in Blue e℠.

Please see the related policy notification for more information.  

This change will apply to Commercial, Inter-Plan Program (IPP) Host and Medicare Advantage (MA). This will not apply to IPP Home or Federal Employee Program® (FEP).

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.

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