NCMS Issues Letter to BCBSNC on Behalf of More Than 20 State Organizations


On May 1, 2024 Blue Cross Blue Shield of North Carolina posted notification of a significant coverage change.  According to the BCBSNC announcement, 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 asserts that the payment reductions are based on “duplicate and overlapping professional practice expenses.”  

The NCMS has heard from many members and practices across the state about the impact the new policy will have on patients and practice stability.  The NCMS has pushed back on the reimbursement cuts and, along with many medical/specialty society partners, has issued a letter opposing the announced changes to the insurer’s Evaluation and Management Service policy.  The Society is unified with our partner organizations in the collective opinion that policies that deny or reduce payment for E/M services reported with a Modifier 25 serve as a disincentive for physicians to provide unscheduled services, which may force patients to schedule multiple visits and jeopardizes quality patient care.  

Further, it is the Medical Society’s contention that the process for establishing valuation for services provided includes adjustments to account for the alleged “overlap” and that any additional reduction in payment for services makes the reimbursement cut duplicative.  The Society plans to meet with BCBSNC to further express concerns and seek a recension of the policy.   


The letter with full list of co-signers: