Reimbursement policy for preadmission and preoperative services

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) updated their reimbursement policy for Preadmission and Preoperative Services. Preadmission and preoperative services are currently bundled if performed at the same hospital as the subsequent surgical procedure/admission.

Effective August 29, 2023:

• Preadmission and preoperative services performed at any facility within a health system using the same federal tax ID will not be separately reimbursed.

Please review the reimbursement policy notifications (PDF) that were communicated previously for commercial plans for further information.

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