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BlueSpeak Provider Newsletter — July 2026
Effective date
Jan 1, 2027
Identified
Jul 28, 2026
Summary
Blue KC is changing its maternity billing for all lines of business to align with AMA coding changes that eliminate traditional global maternity billing codes effective January 1, 2027, so providers will submit claims throughout the pregnancy instead of one global claim at delivery. Other updates include prior authorization additions for Commercial and ACA plans effective September 1, 2026, a hemodialysis URR modifier requirement effective July 1, 2026, and a post-payment review partnership with Cotiviti beginning October 1, 2026.
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What to do
Action · 15 steps
01Future transition January 1, 2027: Providers should evaluate their clinical, billing and EHR workflows now to prepare for the move from global maternity billing to encounter-based billing, and begin changing how maternity services are billed so services performed on or after January 1, 2027 are reimbursed accurately.
02Already effective September 1, 2026: Blue KC encourages changing how E/M codes are billed for prenatal visits for patients expected to deliver on or after January 1, 2027, and encourages review of ACOG and AMA guidance.
03Already effective September 1, 2026: Codes 0686T, 43210, 62362, 63650, 63655, 63663, 63664 and 63685 are on the prior authorization list for Commercial and ACA plans.
04Already effective July 1, 2026: Report CPT 90999 for facility dialysis with the most recent URR modifier (G1 through G6), because facility claims billed without a URR modifier will be denied and a corrected claim must be submitted.
05Already effective July 1, 2026: Report C1776 on the same claim as the surgical procedure and report only one unit for shoulder, knee or hip replacements.
06Claims with more than one unit will be denied, and if the additional units were medically necessary, supporting documentation showing the reasons and medical reasonableness may be sent for review.
07Anchors and screws may be billed separately with C1713 and C1741.
08Already effective July 1, 2026: For claims allowing $1M or more, medical records and/or itemized bills may be required for prepay review, sent by fax to 816-926-4258.
09Already effective October 1, 2026: Revenue code 0710 for recovery room is only allowed on the day of surgery and must be reported with a valid anesthesia revenue code 037X, or the claim will be denied for incomplete or incorrect data.
10Ongoing reminder for chiropractic claims under POL-PP-212: each spinal region manipulated must be supported by a corresponding diagnosis, the level of each subluxation must be specified in the medical record and listed as the primary diagnosis on the claim, and terms such as all spinal regions do not support the service.
11If a claim is denied, a written inquiry with documentation may be submitted.
12Already effective October 1, 2026: Cotiviti performs post-payment data-mining reviews for incorrect contracted rate, claim coordination, modifier reduction, units, duplicate payments, and coordination of benefits.
13Referring providers ordering lab tests should confirm diagnosis codes are complete, accurate and support medical necessity before ordering, because independent labs cannot change diagnosis codes and missing or invalid modifiers cause clinical edit denials.
14If a test is not covered, inform the member before services and explain potential out-of-pocket costs.
15No effective date stated for CGM: Blue KC reimburses implantable CGM systems when medically necessary under provider buy and bill using 0446T and 0448T, and the device is not separately reimbursed through DME, the specialty pharmacy benefit, a manufacturer replacement program or any other reimbursement source.
Codes mentioned
43210623626365063655636636366463685989409894290999C1776C1713C1741E0691E0692E0693E0694
Original notice
BlueSpeak Provider Newsletter — July 2026
providers.bluekc.com · Always check the source before changing claims.
Related changes
See all Blue Cross and Blue Shield of Kansas City changes →BlueSpeak Provider Newsletter — June 2026HighEffective Jul 1, 2026 · Provider NewsBlueSpeak June 2026: Payment Policy UpdatesHighEffective Jul 1, 2026 · Claims & BillingBlueSpeak Provider Newsletter — August 2026HighEffective Nov 1, 2026 · Provider NewsBlueSpeak July 2026: Provider EducationHighEffective Jul 1, 2026 · Provider NewsBrowse every Blue Cross and Blue Shield of Kansas City change in the policy list
Related policy hubs
Blue Cross and Blue Shield of Kansas City policiesOB-GYNOrthopedicsChiropracticNephrologyPain ManagementPathologyEndocrinologyPharmacyDermatologyPediatricsCode 43210Code 62362Code 63650Code 63655Code 63663Code 63664Code 63685Code 98940Code 98942Code 90999Code C1776Code C1713Code C1741Code E0691Code E0692Code E0693Code E0694