Reimbursement policy update: Review billing requirements for Evaluation and Management Services and Supply & Equipment

Effective November 1, 2026, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has updated the billing requirements for Evaluation and Management (E/M) Services and Supply & Equipment before submitting claims.

Claims should be submitted with all required coding, modifiers, diagnoses, and supporting documentation. Providers should also ensure applicable frequency limitations and other billing requirements are met.

For hospital E/M services, providers should review coding selections when multiple hospital visits occur within a short timeframe. Depending on the circumstances, a subsequent hospital care code may be appropriate rather than an initial hospital care code.

Reviewing billing requirements before claim submission can help reduce claim adjustments and support accurate reimbursement.

Medicare Supply and Equipment policy updates

Effective November 1, 2026, the Medicare Supply and Equipment reimbursement policy will include:

• Modifier GL and electric hospital beds
• Modifier LT/RT and orthoses
• Orthotic repair labor
• Gradient compression wraps and garment limits
• Lymphedema compression treatment
• Eyeglass lens limits
• Wound care sets
• Non-implantable durable medical equipment (DME)
• Respiratory assist devices
• Diabetic supplies reimbursement guidance

For additional details, review the related Medicare reimbursement policy notification.

Applicability

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