New reimbursement policy: Critical care with home discharge

January 1, 2026, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is implementing a new Critical Care with Home Discharge reimbursement policy.

Blue Cross NC does not allow reimbursement for critical care services performed during an Emergency Department encounter (045x), ER Facility Claims when the member is discharged to home on the same or next day (discharge status 01). Please see the related policy notification for more information.

Blue Cross NC is making this change to ensure accurate and consistent coding and reimbursement for critical care services.

This new policy will apply to Commercial, Inter-Plan Program (IPP) Host, and Medicare Advantage (MA). This will not apply to IPP Home or Federal Employee Program (FEP).