CommercialReimbursementMedium impact
PAP258 - Bilateral Procedures - Added date range for policy applicability
Blue Cross of Idaho·ID · Orthopedics, General Surgery, Cardiothoracic Surgery +8 more·Medical Policy
Effective date
Feb 1, 2023
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated their bilateral procedures policy (PAP258) to add a specific date range for applicability, effective February 1, 2023. The policy clarifies that bilateral pricing at 150% of maximum allowed amount applies to surgical CPT codes 10000-69999 with CMS bilateral indicator '1' when multiple units are billed.
Action Required
Immediately: Billing team should verify that billing software correctly applies 150% pricing for bilateral surgical procedures (CPT codes 10000-69999 with CMS bilateral indicator '1') when multiple units are billed on same claim. Ensure multiple surgical procedures meeting both MPR and bilateral criteria are priced at 75% of maximum allowed amount. Update billing staff training on bilateral pricing rules for Blue Cross of Idaho claims.