Important News
Future Development of National Consumer Cost Tool for BCBSNC Members
In efforts to empower Blue Plan members in their health care decision-making process, Blue Cross and Blue Shield of North Carolina (BCBSNC) has partnered with other Blue Plans to help build the National Consumer Cost Tool (NCCT). NCCT is a new transparency tool that will provide estimated total cost information for some of the most common, elective services at hospitals, ambulatory surgery centers and imaging centers across the country.
Select Blues Plans will begin sharing this cost estimate data by use of the NCCT tool starting January 1, 2011. BCBSNC already offers to our members an online Health Care Cost Estimator through our secure bcbsnc.com site for members. In the next few years we'll make the transition and extend the NCCT cost estimate tool to BCBSNC membership and we'll share details with providers in advance of making that change.
The cost estimate information* available from the NCCT is derived from Blue claims data from Blue Plans across the country. With the launch of NCCT in the future, our members will be able to log into a secure cost tool on the BCBSNC web site, choose a treatment category, select a ZIP code and find facilities that offer the selected treatment along with estimated cost ranges. NCCT allows members to access average network cost ranges for a variety of common, elective treatment options and conditions, including facility, professional and ancillary procedures.
*The cost estimates are a guide and reflect the average claim allowed amount for the facility and any related physician or diagnostic/other related services included in the admission or outpatient date of service.
Through the NCCT, BCBSNC members will have the future availability to access cost estimates for the following procedures:
| Treatment Category Code | Treatment Category Type Code | Procedure Name |
|---|---|---|
| 00101 | 2 | Bariatric Surgery - Laparoscopic Gastric Bypass |
| 00201 | 2 | Cardiac Angioplasty - with Drug Eluting Stent |
| 00301 | 2 | Cardiac Defibrillator Implant without Cardiac Catheterization |
| 00401 | 2 | Coronary Bypass (CABG) without Cardiac Catheterization |
| 00501 | 2 | C-Section Delivery |
| 00502 | 2 | Vaginal Delivery |
| 00601 | 2 | Hip Replacement |
| 00701 | 2 | Hysterectomy |
| 00801 | 2 | Knee Replacement |
| 00901 | 2 | Laminectomy - Inpatient |
| 01001 | 2 | Spinal Fusion (Anterior) |
| 01002 | 2 | Spinal Fusion (Posterior) |
| 01101 | 1 | ACL Repair by Arthroscopy |
| 01201 | 1 | Back Surgery - Laminectomy |
| 01301 | 1 | Bariatric Surgery (Lap Band) |
| 01401 | 1 | Bladder Repair For Incontinence (Sling) |
| 01501 | 1 | Breast Biopsy Percutaneous w/Imaging |
| 01502 | 1 | Breast Biopsy w/Device |
| 01601 | 1 | Breast Lumpectomy |
| 01701 | 1 | Bunionectomy |
| 01801 | 1 | Carpal Tunnel |
| 01901 | 1 | Cataract Removal |
| 02001 | 1 | Dilation & Curettage - D&C |
| 02101 | 1 | Hammertoe Correction |
| 02201 | 1 | Hernia Inguinal Repair 5 Years and Older |
| 02301 | 1 | Knee Arthroscopy with Cartilage Repair |
| 02401 | 1 | Laparoscopic Gall Bladder Removal |
| 02501 | 1 | Laparoscopic Removal of Ovaries and/or Fallopian Tubes |
| 02601 | 1 | Laparoscopic Tubal Block or Tubal Ligation |
| 02701 | 1 | Left Heart Catheterization |
| 02801 | 1 | Lithotripsy - Fragmenting of Kidney Stones |
| 02901 | 1 | Nasal/Sinus - Corrective Surgery – Septoplasty |
| 03001 | 1 | Nasal/Sinus - Endoscopy - Sinus Surgery |
| 03101 | 1 | Shoulder Arthroscopy |
| 03102 | 1 | Shoulder Arthroscopy with Rotator Cuff Repair |
| 03201 | 1 | Tonsillectomy and Adenectomy, under age 12 |
| 03301 | 1 | Tympanostomy |
| 03401 | 1 | Upper GI Endoscopy |
| 03402 | 1 | Upper GI Endoscopy with Biopsy |
| 03501 | 1 | Colonoscopy with Biopsy |
| 03601 | 1 | Screening Colonoscopy |
| 03701 | 1 | Bronchoscopy |
| 03801 | 1 | Urethra and Bladder Scope |
| 03901 | 3 | Analog Mammography |
| 04001 | 3 | Digital Mammography |
| 04101 | 3 | CT Scan Abdomen |
| 04201 | 3 | CT Scan Head |
| 04301 | 3 | CT Scan Pelvis |
| 04401 | 3 | MRI Brain |
| 04501 | 3 | MRI Lower Limb |
| 04601 | 3 | MRI Spine |
| 04701 | 3 | MRI Upper Limb |
| 04801 | 3 | MRI Lower Limb with Joint |
| 04901 | 3 | Bone Density study of spine or pelvis |
| OFFICE VISITS - The first three digits identify the Treatment Category Group for the Web Service inquiry | ||
| (050) | Chiropractic | |
| 05001 | 4 | Chiropractic treatment, including consultation, manipulation and therapy |
| (051) | Well Woman | |
| 05101 | 4 | Periodic Well Woman GYN exam |
| (052) | Physician Care Existing Patient | |
| 05201 | 4 | Physician Care Existing - Short visit (low to moderate severity) |
| 05202 | 4 | Physician Care Existing - Moderate visit (moderate to high severity) |
| 05203 | 4 | Physician Care Existing - Long visit (high severity) |
| (053) | Physician Care New Patient | |
| 05301 | 4 | Physician Care New Patient - Short visit (low to moderate severity) |
| 05302 | 4 | Physician Care New Patient - Moderate visit (moderate to high severity) |
| 05303 | 4 | Physician Care New Patient - Long visit (high severity) |
| (054) | Pediatric Well Visits | |
| 05401 | 4 | Pediatric Well Visit - Preventive checkup for a well child ages 1-11 |
| 05402 | 4 | Pediatric Well Visit - Preventive checkup for a well child ages 12-18 |
Legend for Treatment Category Type Codes:
- - Outpatient Procedure
- - Inpatient Procedure
- - Diagnostic/Other
- - Office Visits
Prior to providing our members with access to this online information, we will invite you and/or your staff to review the data.
BCBSNC's implementation of the NCCT within the next few years presents an opportunity for BCBSNC to offer a secure, interactive environment where consumers can evaluate cost-related information and become better informed about the estimated costs of future procedures and participate more effectively in their health care decisions. We hope that you, as a trusted health care provider share our enthusiasm for the launch of this innovative member tool.
As always, we value your input and are open to your comments or any concerns. BCBSNC's regional Network Management representatives are available to discuss any questions or concerns you may have about the NCCT tool.