CommercialBilling CodesHigh impact
Telemedicine modifier – Claims edit effective September 1, 2026
Blue Cross Blue Shield of Rhode Island·RI · Psychiatry·Physician / Behavioral Health
Effective date
Sep 1, 2026
We identified it
Sep 1, 2026
Summary
Effective September 1, 2026, Blue Cross Blue Shield Rhode Island will implement a system-level claims edit that denies any claims submitted with telemedicine modifiers (93, 95, FQ, or GT) unless paired with place of service code 02 or 10. Practices must immediately audit billing workflows to ensure telemedicine modifiers are only used when the appropriate telemedicine place of service is documented to avoid claim denials.
Action Required
By August 31, 2026: Billing team must implement system edits and manual verification procedures to prevent submission of claims containing telemedicine modifiers (93, 95, FQ, GT) with place of service codes other than 02 (telehealth - patient home) or 10 (telehealth - patient's location). Actions: (1) Update billing software validation rules to flag or block non-compliant combinations; (2) Audit all existing encounter templates and standing orders to remove telemedicine modifiers from in-office visit types; (3) Train providers and clinical staff on correct modifier usage—telemedicine modifiers must ONLY be used when POS 02 or 10 is selected; (4) Review recent claims (past 90 days) for non-compliant billing patterns and resubmit with corrections if needed. Consequences: Claims billed with telemedicine modifiers and incorrect place of service will be automatically denied by BCBS RI system starting September 1, 2026, resulting in revenue loss and delayed reimbursement. Contact ProviderRelations@bcbsri.org with questions.