Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Blue Cross Blue Shield of Rhode IslandCommercial · Administrative · Physician / Facility · 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

BCBS Rhode Island is removing pre-payment review requirements for CPT codes 43239 (EGD with biopsy) and 45380 (colonoscopy with biopsy) when submitted with Modifier 59 or X modifiers, effective May 1, 2019. However, providers must still retain supporting documentation and ensure proper coding before claim submission.

Get alerts when payers change rules like this one

We check Blue Cross Blue Shield of Rhode Island and other payers every day and email you when a change matches your specialty and state.

Get Blue Cross Blue Shield of Rhode Island alertsPolicy Monitoring is free. No card required.

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).
02Providers must continue to verify NCCI edits before claim submission and ensure documentation supports modifier use.
03Medical records staff must retain all supporting documentation for these services.

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 / Behavioral HealthBrowse 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

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account