Summary
Starting August 15, 2018, claims with modifier 59 or XE, XP, XS, or XU for five listed codes must be filed on paper with supporting documentation, and claims filed electronically or without documentation are denied as provider liability. Effective August 1, 2018, CPT 96161 is covered for Commercial members up to 12 months of age. Effective September 1, 2018, providers begin submitting a new Modifier 22 Unusual Procedural Service Form.
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What to do
Action · 6 steps
01Already effective August 15, 2018: For the five codes that need paper submission when filed with modifier 59 or X{EPSU} (43239, 45380, 7054, 76942, 92250), file the claim on a CMS-1500 form with the supporting medical records.
02If a claim was not reviewed because of incorrect submission after August 15, 2018, submit an adjustment on the Physician/Provider Claim Adjustment Request form.
03Already effective August 1, 2018: Commercial members up to 12 months of age can receive CPT 96161 as covered care under the Preventive Services for Commercial Members policy.
04Primary care providers can generate a web-based referral retroactively within 90 days of a specialist visit in the web-based referral tool.
05Effective September 1, 2018: Begin submitting the new Modifier 22 Unusual Procedural Service Form.
06Check current applicability with BCBSRI before acting on these items.
Codes mentioned
4323945380769429225096161Z68.1Z68.45
Original notice
August 2018
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →Updated submission requirements for claims using Modifier 59 and XMediumEffective May 1, 2019 · Physician / FacilityUpdated submission requirements for claims using Modifier 59 and XMediumEffective May 1, 2019 · Physician / Behavioral HealthModifier 59 UpdateMediumEffective Jan 20, 2020 · Physician / FacilityJanuary 2017MediumNo effective date · Provider UpdateBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list