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1 jun, 2019

Coding and Payment Guideline policy

The Coding and Payment Guideline policy has been updated to reflect that while BCBSRI has adopted CMS payment policies with respect to bilateral services, there are limited cases in which CMS and CPT coding guidelines may differ in the correct use of modifier 50. In those cases BCBSRI will follow the CPT coding guidelines. For example, some CPT codes have “unilateral or bilateral" in the descriptor making it clear the service is inherently bilateral. While CMS may allow use of a bilateral modifier, BCBSRI will follow CPT guidelines and deny the claim if filed with a bilateral modifier. Please see the full text of this policy here.