Enhanced Editing Affecting Bundling Guidelines

Effective August 1, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is implementing enhanced editing in Bundling Guidelines regarding comprehensive services.

Blue Cross NC will be implementing enhancements to our claims processing system that reflect guidelines set forth by industry authorities to process claims consistently and in accordance with best practice standards detailed further in the links below. The policy will enforce guidelines regarding comprehensive code submission and radiology services.

Specific services impacted include, but are not limited to, “spot film” single view radiologic exams, rib and chest radiologic exams, and entire spine radiologic exams. For more information, review the Medicare Reimbursement Policy notifications and Commercial plan Reimbursement Policy Notifications.

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.