(RALEIGH) — One day after the North Carolina Medical Society announced it organized a coalition of more than 20 state organizations in opposition to a coverage change at Blue Cross Blue Shield NC, the policy has been rescinded.

On May 1, 2024, BCBSNC posted notification of a significant coverage change, saying the payor “will begin reimbursing evaluation and management services at fifty percent (50%) when performed by the same provider/group practice on the same day as a minor procedure.”  The services in question are those that are reported with a Modifier 25 to indicate that a patient’s condition required a significant and separate evaluation and management (E/M) service on the same day as another procedure or service.

BCBSNC asserted that the payment reductions are based on “duplicate and overlapping professional practice expenses.”  

The NCMS disagreed and, after hearing from members and practices across the state, mobilized 23 organizations and medical societies to push back on the cut.  NCMS CEO Chip Baggett says, “our concern is always to protect the quality of patient care and the viability of professional practices.”

On Thursday, BCBSNC communicated they would rescind the policy update indefinitely.  They went on to say, “We are committed to partnering with you (the NCMS and other organizations) to ensure quality care and appropriate billing practices; while also working to make sure healthcare is affordable in North Carolina.”  NCMS appreciates the openness to dialogue and change that BCBS NC exhibited during this time.

Baggett adds that this victory puts the spotlight on the hard work of the NCMS.  “Relationships matter,” he says, “and without our relationships with members and other organizations in the state this would not have happened.”  He also praised the quick communications of everyone involved.

“This really demonstrates how a commitment to putting patients first works.  Our core value of protecting the people of North Carolina has led us to this day.  We are very happy to share in this victory and look forward to our continuing efforts with our members and partner agencies.”

To read the full release from Blue Cross Blue Shield North Carolina click here.