Providers

Pricing policies and fee schedules

This Pricing Development and Maintenance Policy applies to the calculations of contractual allowances ("fees") for services billed on a CMS-1500, UB-04, or successor claim form to Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
alignment
center
size
large
text
Review Fee Schedules
variant
filled
button-type
lh-button
srtext
Learn how to access your fee schedules
link
#fee-schedules
data-path
#fee-schedules
target
_self
media-label
label
icon
lh-icon--arrow-down
icon-position
right
analytics-id
hero-cta-1-8f72b2067a-1c2758e4ec-Pricing policies and fee schedules
full-width
false
full-width-mobile
false
is-hero
true
no-alt-text
true
hide-image-mobile
false
sticky-bar-enabled
false
show-sticky-text-mobile
false
lh-overlay
false
lh-theme
primary-extra-dark
lh-alignment
center
lh-content-width
md
lh-padding-top
xl
lh-padding-bottom
xl
lh-margin-top
none
lh-gutters
tight

In-network pricing policies

Commercial CMS-1500 pricing policies

orientation
vertical
size
small
text
2008 Pricing Development and Maintenance Policy (PDF)
variant
text
button-type
lh-button
srtext
2008 Pricing Development and Maintenance Policy (PDF)
link
/content/dam/bcbsnc/pdf/providers/policies-guidelines-codes/pricing-policies-fee-schedules/2008-pricing-policy.pdf
target
_blank
media-label
label
analytics-id
dynamic-list-item-eb701aa07f-613522df21-2008 Pricing Development and Maintenance Policy (PDF)
full-width
false
full-width-mobile
false
text
Opioid Treatment Programs (OTP) Pricing Policy (PDF)
variant
text
button-type
lh-button
srtext
Opioid Treatment Programs (OTP) Pricing Policy (PDF)
link
/content/dam/bcbsnc/pdf/providers/policies-guidelines-codes/pricing-policies-fee-schedules/opioid-treatment-programs-pricing-policy.pdf
target
_blank
media-label
label
analytics-id
dynamic-list-item-eb701aa07f-d105e65538-Opioid Treatment Programs (OTP) Pricing Policy (PDF)
full-width
false
full-width-mobile
false
text
Pricing Development and Maintenance Policy CCS BETOS (PDF)
variant
text
button-type
lh-button
srtext
Pricing Development and Maintenance Policy CCS BETOS (PDF)
link
/content/dam/bcbsnc/pdf/providers/policies-guidelines-codes/pricing-policies-fee-schedules/ccs-betos-pricing-policy.pdf
target
_blank
media-label
label
analytics-id
dynamic-list-item-eb701aa07f-8e29302713-Pricing Development and Maintenance Policy CCS BETOS (PDF)
full-width
false
full-width-mobile
false
text
Pricing Policy for Procedure/Service Codes (Applicable to all PPO, POS and HMO products) (PDF)
variant
text
button-type
lh-button
srtext
Pricing Policy for Procedure/Service Codes (Applicable to all PPO, POS and HMO products) (PDF)
link
/content/dam/bcbsnc/pdf/providers/policies-guidelines-codes/pricing-policies-fee-schedules/non-2008-pricing-policy.pdf
target
_blank
media-label
label
analytics-id
dynamic-list-item-eb701aa07f-0b467317ad-Pricing Policy for Procedure/Service Codes (Applicable to all PPO, POS and HMO products) (PDF)
full-width
false
full-width-mobile
false

Commercial UB-04 pricing policies

orientation
vertical
size
small
text
Specialty Rx Outpatient Pricing Policy (PDF)
variant
text
button-type
lh-button
srtext
Specialty Rx Outpatient Pricing Policy (PDF)
link
/content/dam/bcbsnc/pdf/providers/policies-guidelines-codes/pricing-policies-fee-schedules/specialty-rx-outpatient-pricing-policy.pdf
target
_blank
media-label
label
analytics-id
dynamic-list-item-33bc7d2d31-855bb74dcc-Specialty Rx Outpatient Pricing Policy (PDF)
full-width
false
full-width-mobile
false

Medicare pricing policies

orientation
vertical
size
small
text
Pricing policy for Medicare Part B procedure/service codes (applicable to all PPO, POS and HMO products) (PDF)
variant
text
button-type
lh-button
srtext
Pricing policy for Medicare Part B procedure/service codes (applicable to all PPO, POS and HMO products) (PDF)
link
/content/dam/bcbsnc/pdf/providers/policies-guidelines-codes/pricing-policies-fee-schedules/medicare-pricing-policy.pdf
target
_blank
media-label
label
analytics-id
dynamic-list-item-810993379e-f1d08fcd39-Pricing policy for Medicare Part B procedure/service codes (applicable to all PPO, POS and HMO products) (PDF)
full-width
false
full-width-mobile
false

Out-of-network pricing policies

orientation
vertical
size
small
text
Out of Network (OON) Reimbursement Policy and Fee Schedule (PDF)
variant
text
button-type
lh-button
srtext
Out of Network (OON) Reimbursement Policy and Fee Schedule (PDF)
link
/content/dam/bcbsnc/pdf/providers/policies-guidelines-codes/pricing-policies-fee-schedules/out-of-network-reimbursement-policy-fee-schedule.pdf
target
_blank
media-label
label
analytics-id
dynamic-list-item-ab61a5da88-c27841b8c3-Out of Network (OON) Reimbursement Policy and Fee Schedule (PDF)
full-width
false
full-width-mobile
false
lh-id
container-778c4447e1
lh-context-id
container-778c4447e1
lh-theme
neutral-light
lh-spacing
default
lh-content-width
md
lh-gutters
default
lh-padding-top
md
lh-padding-bottom
xl

Fee schedules

Blue Cross NC provides fee schedule information electronically to participating physicians.

Providers looking for past allowed fee schedule amounts should contact Network Management. Participating physicians who wish to view a special or supplemental fee schedule can contact Network Management to request a hard copy of the fee schedule.
lh-id
container-f0eb4d1b27
lh-context-id
container-f0eb4d1b27
lh-theme
primary-light
lh-spacing
default
lh-content-width
md
lh-gutters
default
lh-padding-top
md
lh-padding-bottom
sm
is-grid
true
grid-gap
default
lh-id
container-f2d29e05d6
lh-theme
primary-light
lh-spacing
default
lh-content-width
xl
lh-padding-top
sm
lh-padding-bottom
sm
lh-gutters
default
layout
vertical-left
theme
white
media-type
none
gradient
true
title
Professional Commercial CMM, EPO, HMO, POS, and PPO fee schedules
heading-level
h3
heading-size
sm
rte-description
Participating providers filing claims under CMM, EPO, HMO, POS, and PPO lines of business can find their fee schedule in Blue e.
cta1-variant
outlined
cta1-text
Access Fee Schedule in Blue e
cta1-href
https://bluee.bcbsnc.com/providers/web/
cta1-analytics-id
card-1-6e5f329767-b783019bbf-bluee.bcbsnc.com
is-grid-item
true
span
6
span-tablet
6
span-mobile
12
desktop-span
6
tablet-span
6
mobile-span
12
vertical-align
stretch
layout
vertical-left
theme
white
media-type
none
gradient
true
title
Blue Medicare HMO and Blue Medicare PPO fee schedules
heading-level
h3
heading-size
sm
rte-description
Contact Network Management
Phone: 800-777-1643
Fax: 919-765-4349
Email: ProviderUpdates@bcbsnc.com
is-grid-item
true
span
6
span-tablet
6
span-mobile
12
desktop-span
6
tablet-span
6
mobile-span
12
vertical-align
stretch
layout
vertical-left
theme
white
media-type
none
gradient
true
title
CCS BETOS code list by category
heading-level
h2
heading-size
sm
rte-description
The CCS BETOS code list organizes medical billing codes by category, combining Clinical Classification Software (CCS) and Berenson-Eggers Type of Service (BETOS) codes to support efficient analysis of healthcare utilization, costs, and trends.
cta1-text
Review List Organized By Category (PDF)
cta1-href
/content/dam/bcbsnc/pdf/providers/policies-guidelines-codes/pricing-policies-fee-schedules/ccs-betos-codes-by-category.pdf
cta1-target
_blank
cta1-variant
outlined
cta1-analytics-id
card-1-1abf0caaa3-c9998d651a-CCS BETOS code list by category
is-grid-item
true
span
6
span-tablet
6
span-mobile
12
desktop-span
6
tablet-span
6
mobile-span
12
vertical-align
stretch

Fee schedules FAQ

reference-format
faq
path
match
OR
order-by
meta.navtitle.keyword
sort-order
ASC
max-items
10
lh-id
container-50667053ec
lh-context-id
container-50667053ec
lh-theme
primary-light
lh-spacing
default
lh-content-width
md
lh-padding-top
md
lh-padding-bottom
md
lh-gutters
default