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Medicare Pricing Policy Update

Release Date: August 31, 2012

When new codes are published, or updates to existing codes occur, and an external pricing source exists for such codes, BCBSNC will implement such pricing by no later than April 1 of each year or within 30 days of source publication.  Such updates and new pricing will apply for all dates of service on or after the source pricing effective date, but only for claims received after the date of BCBSNC’s implementation of the update/new pricing.  BCBSNC is not required to make retroactive pricing adjustments for claims received prior to BCBSNC’s implementation date. 

This pricing policy update is being made to provide additional clarification of BCBSNC’s existing policy and practices.