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Blue Cross Blue Shield of Rhode IslandCommercial · Administrative · Physician / Behavioral Health · RI · GastroenterologyMedium impact

Updated submission requirements for claims using Modifier 59 and X

Act
immediately
Effective date
May 1, 2019
Identified
Jun 20, 2026

Summary

BCBSRI has removed CPT codes 43239 (EGD with biopsy) and 45380 (colonoscopy with biopsy) from pre-payment review requirements when used with Modifier 59 or X modifiers, effective May 1, 2019. Medical records no longer need to be submitted for these codes, but proper documentation must still be maintained and NCCI edits verified before claim submission.

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What to do

immediately · 3 steps
01Billing team should update procedures to no longer submit medical records for CPT 43239 and 45380 when using Modifier 59 or X modifiers (XE, XP, XS, XU) for BCBSRI claims.
02Continue to verify NCCI edits exist before submission and ensure documentation supports modifier use.
03Providers must maintain proper documentation in medical records as post-payment reviews may still occur.

Codes mentioned

4323945380

Original notice

Updated submission requirements for claims using Modifier 59 and X
bcbsri.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross Blue Shield of Rhode Island changes →
August 2018MediumEffective Aug 15, 2018 · Provider UpdateUpdated submission requirements for claims using Modifier 59 and XMediumEffective May 1, 2019 · Physician / FacilityBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list

Related policy hubs

Blue Cross Blue Shield of Rhode Island policiesRI policy changesGastroenterologyCode 43239Code 45380

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