Summary
BCBSRI has removed three specific procedure codes (70544, 76942, 92250) from pre-payment review requirements when billed with Modifier 59 or X-modifiers, effective January 20, 2020. These codes no longer require medical record submission but providers must still verify NCCI edits and ensure proper documentation supports modifier use.
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What to do
immediately · 3 steps
01Update billing workflows to remove pre-payment review submission requirements for CPT codes 70544, 76942, and 92250 when using Modifier 59 or X-modifiers (XE, XP, XS, XU).
02Billing team must continue verifying NCCI edits before submission and ensure medical record documentation supports modifier usage.
03Maintain supporting documentation in patient records as BCBSRI will monitor usage patterns for potential post-payment reviews.
Codes mentioned
705447694292250
Original notice
Modifier 59 Update
bcbsri.com · Always check the source before changing claims.