Reimbursement policy update: Multiple and bilateral surgery

Effective September 1, 2026, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is updating its Multiple and Bilateral Surgery reimbursement policy for facility and professional claims when multiple surgical procedures are performed on the same day by the same provider or provider group.

Outpatient facility reimbursement will pay 100% of the Blue Cross NC allowance for the primary procedure and 50% for the secondary and third procedure performed on the same day. Additional procedures will not be eligible for reimbursement.

Professional reimbursement will be allowed at 25% for the third and subsequent procedures.

This update does not apply to Ambulatory Surgical Centers.

See the related Commercial policy notification and refer to the Provider Blue Book for more information.

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