Dear Provider,
We are writing to share important updates from BCBSNC regarding the billing of Traction (97012) and Unattended Electrical Stimulation (97014) for patients subject to the BCBSNC PA for PT Program, as well as new guidance related to the participation of self-funded plans in the Program beginning July 1, 2025.
Billing of 97012 and 97014 on Initial Visits
As you know, services performed on initial visits are not subject to the PA for PT Program.
As a result, and significantly, BCBSNC has now confirmed that
Traction (97012) and Unattended Electrical Stim (97014)
provided and billed on initial visits
will not be denied for patients whose plans are subject to the Program.
While the PA for PT Program/Carelon Clinical Guidelines continue to deem these services medically unnecessary (i.e., non-covered) for all visits following the initial visit, you may submit claims for these services to BCBSNC when performed on the initial visit and expect reimbursement.
PA for PT Program Available to Self-Funded Plans Effective 7/1/2025
As previously communicated, BCBSNC will allow self-funded groups to opt-in to the PA for PT Program for dates of service on or after July 1, 2025. Participation is optional for these groups. You can read the full announcement from BCBSNC here: Rehabilitation Program Available to ASO Plans Effective 07/01/2025.
Importantly, to assist you in navigating these changes, HNS has updated the guidance in our BCBSNC Physical Therapy Prior Authorization Summary Sheet.
To properly obtain PA and avoid denials, please be sure you and your billing CA thoroughly understand the PA program and follow all directions included in the revised Summary Sheet above.
As always, HNS will continue to update the BCBSNC Physical Therapy Prior Authorization Summary Sheet, as well as the BCBS-Carelon section of the HNS website, with any additional information we learn about the BCBS PA program, and will notify the network of any pertinent updates.
Upon review of the information above, if you have any questions, please do not hesitate to contact your HNS Service Representative.
Sincerely,
HNS