Pricing Policy Updates Effective January 1, 2025

To provide better clarity around our pricing policies Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is making the following changes effective January 1, 2025.

The following language has been updated throughout our policies regarding the timing of pricing updates annually and quarterly:

1. Such updates and new pricing will apply for all dates of services on or after the source pricing effective date, but only for claims received after the date of Blue Cross NC’s implementation of the update/new pricing. Blue Cross NC does not make retroactive pricing adjustments for claims received prior to Blue Cross NC’s implementation date.

New standalone pricing policies for Specialty Rx Outpatient and MA.

• Specialty Rx Outpatient Pricing Policy (PDF) and Medicare Pricing Policy (PDF)

Additional provider types added to Out-of-Network (OON).

• Reference Laboratory
• Home Health
• Home Infusion Therapy
• Private Duty Nursing
• Home Durable Medical Equipment
• Hospice Service
• Skilled Nursing Facility
• Specialty Pharmacy Services
• Birth Center Services
• Licensed Dietitian Nutritionist Services

In network pricing policies

Commercial CMS-1500 pricing policies

• Non-2008Pricing Policy (PDF)
• 2008 Pricing Policy (PDF)
• CCSBETOS Pricing Policy (PDF)
• Opioid Treatment Programs (OTP) Pricing Policy (PDF)

Commercial UB-40 pricing policies

• Specialty Rx Outpatient Pricing Policy (PDF)

Medicare pricing policies

• Medicare Pricing Policy (PDF)

Out of network pricing policies

• Out of Network (OON) Reimbursement Policy and Fee Schedule (PDF)

If you have any questions related to these changes, please call the Provider Blue Line^℠ at 800-214-4844.