Dear Provider,
HNS recently learned that, effective August 15, 2026, BCBSNC will implement a new E/M Leveling Program for codes 99202-99205 and 99212-99215.
HNS is currently in contact with BCBSNC about the program and will share updates with the network as more information becomes available.
At a high level, BCBSNC will identify select individual providers whose E/M coding patterns are consistently higher than their peers. These providers may undergo additional review using analytic tools and clinical evaluation to assess whether billed services align with national coding standards. If a billed E/M level is not supported by claims data or documentation, the E/M service may be denied or reimbursed at a lower level.
Key Points:
- While the program applies to all provider types (not just chiropractors), inclusion is not automatic; only those individual providers who meet the specified criteria will be included.
- Providers selected for inclusion will receive advance notification from BCBSNC.
- The policy applies to BCBSNC commercial and MA plans and does not apply to FEP or out-of-state plans.
What This Means for Now:
- No action is required unless you are contacted by BCBSNC.
- Continue to ensure E/M services are accurately coded and fully supported by documentation.
- HNS will continue to monitor this policy and provide updates as more information becomes available.
For additional details at this time, please refer to the BCBSNC E/M Leveling Program Announcement.
Sincerely,
HNS