BCBSNC Multiple Therapy Reimbursement Policy (effective 10/1/2026)
The BCBSNC Multiple Therapy Reimbursement Policy governs reimbursement when multiple therapy services and/or units are provided and billed on the same date for the same patient. This policy applies to all plans administered by BCBSNC, including all commercial, FEP, out of state, and self-funded plans. All other BCBSNC policies and programs governing PT services, including the Carelon PA for PT program, remain in effect.
Summary of the Policy
When multiple affected therapy services are billed for the same patient on the same date of service, BCBSNC will identify one therapy service as the primary service. That service will be paid at 100% of the allowable.
Additional affected therapy services billed during
the same visit will be reimbursed at a reduced amount.
The policy also applies when multiple units of the same affected therapy service are billed; only the first unit will be reimbursed at 100%, while additional units will be reimbursed at reduced rates.
To assist with understanding of this policy, HNS has created the following: