Reimbursement policy update: Bundling guidelines of “Incident To” services

Effective July 15, 2026, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is updating its Bundling Guidelines reimbursement policy. Modifier SA is required for “Incident To” services to be considered for reimbursement.

Services performed by providers (including but not limited to nurse practitioners, certified nurse midwives, clinical nurse specialists, certified registered nurse anesthetists and physician’s assistants) that are eligible to submit claims are not eligible for "Incident To" reimbursement. Providers must submit the services under their own NPI, and rendering provider information must be included on the claim. Claims will not be considered unless the submitting provider has been credentialed and enrolled with Blue Cross NC.

Blue Cross NC is implementing this change to ensure consistent reimbursement practices.

See the related Commercial 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 Medicare Advantage or IPP Home.