Medicare Advantage reimbursement policy reminder: NCCI editing

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) follows the Centers for Medicare and Medicaid Services (CMS) guidance on reimbursement related to National Council on Compensation Insurance (NCCI) editing initiatives.

Effective August 1, 2026, and in alignment with CMS, evaluation and management (E&M) services performed on the same day as procedures with a global surgery indicator of “XXX” are not eligible for separate reimbursement unless appropriately appended with Modifier 25. Please see the CMS Medicare NCCI Policy Manual, Chapter 6 (PDF), for more information.

Providers are encouraged to review the CMS policy in detail to ensure compliance and avoid unnecessary administrative burden and future recoupments.