MedicaidBilling CodesHigh impact
Use of Modifier AF - Medicaid Expansion Only
Blue Cross Blue Shield of North Dakota·ND · Psychiatry, General Practice, Family Medicine +1 more·Provider News
Effective date
Aug 17, 2026
We identified it
Aug 29, 2026
Summary
Blue Cross Blue Shield of North Dakota now requires modifier AF on E/M codes 99202-99215 for Medicaid Expansion claims when billed with a primary Behavioral Health diagnosis to receive the Behavioral Health fee schedule. Claims billed with modifier AF without a primary behavioral health diagnosis will be rejected as non-payable (provider liable). This requirement becomes effective for claims processed on or after August 17, 2026.
Action Required
By August 17, 2026: Billing team must implement the following changes for BCBSND Medicaid Expansion claims: (1) Update billing system rules to automatically append modifier AF to E/M codes 99202-99215 ONLY when a primary Behavioral Health diagnosis code is present on the claim; (2) Configure system edits to reject claims that contain modifier AF without a primary behavioral health diagnosis as non-payable; (3) Train billing and clinical staff that modifier AF is required for BH E/M visits to qualify for Behavioral Health fee schedule rates; (4) Audit encounter forms and templates to ensure providers document behavioral health diagnoses on applicable visits; (5) Review and correct any existing system configurations that may incorrectly apply or omit modifier AF. Failure to implement will result in provider-liable rejections and lost revenue. Contact BCBSND Medicaid Expansion Provider Service at 833-777-5779 for questions or clarification.