Observation Room Services - Reminder
In order to ensure that your facility is correctly billing for observation room services, we encourage you to review the related Blue Cross and Blue Shield of North Carolina (BCBSNC) medical policies noted below and review your facility’s related contract provisions, if needed.
Specifically, we’d like to remind you of the following guidelines:
- BCBSNC commercial contracts state the allowed amount for any observation stay exceeding 24 hours (not to exceed 48 hours as defined by the medical policy below) will be the lesser of the applicable inpatient or outpatient allowed amount.
- Both the BCBSNC provider Blue BookSM (Section 10.59) and the Blue Book Supplemental Guide state that charges related to an observation bed may not exceed the prevalent semi-private daily room rate.
BCBSNC provides coverage for observation room services when they are determined to be medically necessary per the criteria outlined in these related medical policies:
You can find these policies, along with our other BCBSNC medical policies, online via the Provider page at http://www.bcbsnc.com/providers.
*This updated version of the 11/14/2011 article includes the information that the observation stay cannot exceed 48 hours, as well as the specific section of the Blue Book for more details, if needed.