Reimbursement Policy: Bundling Guidelines Shoulder Arthroscopy

Effective September 1, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is updating its Bundling Guidelines reimbursement policy.

Shoulder arthroscopy NCCI PTP edit code pairs performed on the same shoulder are not separately reimbursable, even when an NCCI PTP-associated modifier is present. Unless considered integral to the primary procedure, when performed at the same time as a more complex primary procedure, limited shoulder arthroscopic debridement is not eligible for separate reimbursement.  Please see the related policy notification for more information.

Blue Cross NC is implementing this change to ensure consistent reimbursement practices and enforce guidelines regarding appropriate bundling rules. This aligns with Blue Cross NC’s mission to make healthcare more affordable for all.

This change will apply to Commercial, Inter-Plan Program (IPP) Host, and Federal Employee Program (FEP). This policy is already in place for Medicare Advantage and will not apply to IPP Home.