CommercialBilling CodesMedium impact
Coding and Payment Guideline policy
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jun 1, 2019
We identified it
Jun 20, 2026
Summary
BCBSRI has updated their Coding and Payment Guideline policy regarding bilateral modifier 50 usage. While they adopt CMS payment policies for bilateral services, BCBSRI will follow CPT coding guidelines when CMS and CPT differ, meaning claims with bilateral modifiers will be denied for CPT codes that already describe unilateral or bilateral services.
Action Required
Immediately: Billing team must review all CPT codes with 'unilateral or bilateral' in descriptors and update billing software to prevent use of modifier 50 with these codes for BCBSRI claims. Train staff to identify inherently bilateral procedure codes and bill without bilateral modifiers to avoid claim denials.