CommercialAdministrativeMedium impact
Modifier 59 Update
Blue Cross Blue Shield of Rhode Island·RI · Radiology, Diagnostic Imaging, Ophthalmology·Physician / Facility
Effective date
Jan 20, 2020
We identified it
Jun 19, 2026
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.
Action Required
Immediately: Update 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). Billing team must continue verifying NCCI edits before submission and ensure medical record documentation supports modifier usage. Maintain supporting documentation in patient records as BCBSRI will monitor usage patterns for potential post-payment reviews.