Enhanced Editing for Durable Medical Equipment (DME)

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will be instituting an updated reimbursement policy for DME effective July 18, 2023. We will be implementing enhancements to our claims processing system that reflect guidelines set forth by industry authorities in order to process claims consistently and in accordance with best practice standards.

The updated policy includes an updated list of non-reimbursable DME and will enforce additional modifier requirements for DME purchases and rentals as well as enhanced requirements for billing of supplies and accessories including:

• Wheelchairs
• Oxygen and accessories
• VAD accessories
• Orthotics and prosthetics

Important Notes

• This policy will apply for any claims with date of service 07/18/2023 and later.
• This policy will not affect your reimbursement / payment amounts. Reimbursable services will be paid at the same rates as they previously were.
• These policies will apply to professional and facility claims unless otherwise stated. There are no changes to any processes, , customer service and support, or grievances and appeals. Please refer to the updated policies for details in regards to Modifiers and Supply and Equipment for correct billing guidance.

For more information, please review the Medicare reimbursement policy notifications and commercial reimbursement policy notifications.

This communication applies to State Health Plan (SHP), Administrative Services Only (ASO), Fully Insured, Senior Market Administration (SMA), and IPP Host. It does not apply to FEP or IPP Home claims.