CommercialBilling CodesHigh impact
Important Update to Enhanced Ambulatory Patient Grouping (EAPG)
Blue Cross Blue Shield of North Dakota·ND · Psychiatry·Provider News
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
BCBS North Dakota has eliminated reimbursement for 13 specific behavioral health EAPG codes effective January 1, 2026. These services must now be billed using CMS-1500 claim forms instead of UB-04 forms, and providers may face recoupment for incorrectly paid claims from January 1st forward.
Action Required
Immediately: Billing team must stop using UB-04 forms for the 13 listed behavioral health EAPG codes (309, 310, 315, 316, 317, 319, 320, 321, 323, 328, 329, 333, 4010, 4011) and switch to CMS-1500 claim forms for these services. Update billing system rules to route these services to professional claims processing instead of facility claims. Review and potentially appeal any claims denied since January 1, 2026 due to incorrect payment recoupment.