Enhanced Editing Affecting Radiation Therapy Services

Effective February 1, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is implementing enhanced editing for radiation therapy services.

Blue Cross NC 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 will enforce guidelines regarding appropriate service units, frequency and bundling rules. Specific services impacted include, but are not limited to, intensity modulated radiotherapy planning, brachytherapy, dosimetry and simulation, radiation therapy management and radiation treatment management. For more information, review the Medicare Reimbursement Policy Notification and Commercial Plan Reimbursement Policy Notification.

This policy will apply to professional and facility claims. There are no changes to any processes, including claims submission, customer service and support, or grievances and appeals. This change will apply to Commercial, Medicare Advantage, Inter-Plan Program (IPP) Host, and Federal Employee Program (FEP). It will not apply to IPP Home.