This article is for all providers caring for our members
Blue Cross accepts industry-standard modifiers to allow for clear provider reporting of services and accurate claims processing. When a CPT or HCPCS modifier is reported on a professional or facility claim, the applicable reimbursement information applies to all provider types.
As a reminder, our CPT and HCPCS Modifiers payment policy states:
- Modifiers may affect how claims are processed, how services are priced, and how payment is calculated. Modifiers can also affect how we apply member benefits.
- Claims submitted with modifiers are subject to pre and/or post-pay audit. Medical notes must support services identified by the modifier.
- Blue Cross accepts all standard current procedural terminology (CPT) and healthcare common procedure coding system (HCPCS) modifiers submitted in accordance with the appropriate procedure codes. Certain modifiers, when submitted appropriately, will impact reimbursement.
- The absence or presence of a modifier may result in a claim denial.
Refer to our existing CPT and HCPCS Modifiers payment policy for additional guidelines.
Payment policy application
We have expanded our ability to process claims pre-payment in accordance with our existing payment policy. As a result, this will help reduce the number of claims that need post-payment review.
Resources
- CPT and HCPCS Modifiers payment policy
To download our payment policies, log in and click Find a Payment Policy on the right side of your home page. Or, go to Office Resources>Policies & Guidelines>Payment Policies.
Questions?
If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.
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