Reimbursement policy update: Facility Billing Guidelines

Update: The Facility Billing Guidelines update is effective April 3, 2026. This policy update was originally published February 1, 2026.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has updated our Facility Billing Guidelines reimbursement policy to include guidance regarding end-stage renal disease (ESRD) facility services. Effective April 3, 2026, to be eligible for reimbursement, procedures submitted with bill type 0720-072Z without condition code 84 must include a principal diagnosis of ESRD. If submitted with condition code 84, HCPCS code G0491 for acute kidney injury (AKI) must be appropriately reported.

Please see the related policy notification for more information.

This policy applies to commercial, Inter-Plan Program (IPP) Host, and Federal Employee Program (FEP). This does not apply to IPP Home. This is already applicable to Medicare Advantage.