Policy Changes for Professional Pathology Billing Guidelines

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) communicated revisions to the professional pathology billing guidelines policy (PDF) on September 29, 2020. This policy is in effect as of March 9, 2021, and is available on our Medical Policy updates page.

Professional Pathology Billing Guidance

• This new medical policy includes extensive revisions to pathology billing, as well as updates to the “Description” and “Service Guidelines” sections, and a new “Billing Guidelines” section.
• Blue Cross NC will reimburse professional pathology services in accordance with the new guidelines.
• Claims will be processed according to the new policy. Blue Cross NC has provided a chart for review to ensure providers are billing in the appropriate manner.

These changes apply to the following lines of business: Administrative Services Only (ASO), fully insured membership, IPP Host, Federal Employee Plan (FEP) and the State Health Plan (SHP).

For additional medical policy notifications, please visit our Medical Policy Updates page.