BlueSpeak Provider Newsletter — June 2026

By July 1, 2026: (1) Dialysis billing: Billing team must update system to require URR modifiers (G1, G2, G3, G4, G5, or G6) on all CPT 90999 facility claims. Claims submitted without URR modifiers will be automatically denied effective 7/1/2026—no exceptions. Train dialysis staff on URR modifier selection based on patient's most recent URR percentage. (2) Orthopedic/Joint Replacement: Update billing rules to cap C1776 submissions at 1 unit for shoulder, knee, or hip replacements per claim. If additional units are medically necessary, create documentation template requiring: medical necessity justification, details of additional units, and clinical rationale. Store documentation with claim for appeal review. (3) Chiropractic: Modify billing software to validate that each CMT code (98940-98942) has corresponding diagnosis codes—count of diagnoses must match number of spinal regions. Reject claims that use generic terms like 'all spinal regions' or 'upper and lower regions.' Require providers to document specific vertebral levels (C1-S5) and spinal region names (cervical, thoracic, lumbar, sacrum, pelvic) in medical record. (4) Radiology: By 7/1/2026, review imaging facility network status and establish workflow to route appropriate advanced diagnostic imaging cases to freestanding facilities when site-of-care criteria are met. Hospital-based facility claims for services meeting site-of-care criteria will be denied. (5) Maternity: By September 1, 2026, providers must begin using revised E/M codes for prenatal visits for patients with delivery dates on or after January 1, 2027. Obtain ACOG and AMA guidance; communicate coding requirements to OB/GYN providers and update encounter forms. Coordinate with compliance to monitor for coding errors starting 9/1/2026.