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Revision to multiple surgical procedure guidelines

As of August 2004, when processing claims for multiple surgical procedures, BCBSNC will identify the primary procedure based on the CPT code assigned the highest value by the most current version of ClaimCheck.

We will no longer define the primary procedure as the procedure with the highest charge. BCBSNC will reimburse the primary procedure at 100 percent of the charge, or the fee schedule allowance, whichever is less. Secondary procedures will be reimbursed as 50 percent when the specific criteria in BCBSNC’s multiple surgical procedure medical policy are met.

This new guidelines only impacts members covered by Blue Care®, Blue Choice®, Blue OptionsSM, Classic Blue® and Blue Advantage® (Blue Options network only, identifiable by the alpha prefix "YPP" on their ID cards). This policy does not impact Legacy products.

If you have any questions, please contact your local Network Management office.