CommercialAdministrativeMedium impact
Updated submission requirements for claims using Modifier 59 and X
Blue Cross Blue Shield of Rhode Island·RI · Gastroenterology·Physician / Facility
Effective date
May 1, 2019
We identified it
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.
Action Required
Immediately: Billing 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). Providers must continue to verify NCCI edits before claim submission and ensure documentation supports modifier use. Medical records staff must retain all supporting documentation for these services.