CommercialReimbursementHigh impact
Coding and Reimbursement Policy Update
Blue Cross Blue Shield of North Dakota·ND·Coding
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
BCBS North Dakota updated their E/M billing policy effective January 1, 2026. When billing both a preventive medicine E/M visit and a problem-oriented E/M visit on the same day by the same provider or group, the preventive visit will be reimbursed at 100% but the problem-oriented E/M service will only be reimbursed at 75% of the allowable amount.
Action Required
By January 1, 2026: Billing team must update billing system logic to automatically apply 75% reimbursement rate to problem-oriented E/M visits when billed same day as preventive E/M visits by same provider/group. Update encounter forms to alert providers about reduced reimbursement. Configure system to ensure preventive visit remains at 100% reimbursement.