Medicare AdvantageAdministrativeHigh impact
Remember to use Proper Coding for Evaluation and Management Services, Modifiers and Oncology Drugs and Services for Medicare and Medicaid Claims
BCBS Texas·TX·Pharmacy
Effective date
Mar 1, 2026
We identified it
Jan 12, 2026
Summary
Effective March 1, 2026, Blue Cross Blue Shield Texas will enhance claims editing and review processes to monitor proper use of Evaluation and Management coding, Oncology Drugs and Services coding, and Modifiers 25 and 59. Claims with inaccurate modifier usage may result in delayed or denied payment for Medicare Advantage and Medicaid claims.
Action Required
Before March 1, 2026: Billing team must review and ensure proper use of Modifiers 25 and 59 on all Medicare Advantage and Medicaid claims. Modifier 25 should only be used for significant, separately identifiable E&M services. Modifier 59 should only be used for distinct procedural services. Train coding staff on proper modifier usage and update internal audit processes to catch incorrect modifier application. Improper modifier use will result in delayed or denied claims.