Tuesday, July 27, 2010

BCBS of North Carolina covered modifier

When a Modifier may be covered - BCBS of  North Carolina

• Modifier - 24 can be submitted with evaluation and management services. It is used to report an unre lated evaluation and management service by the same physician during a postoperative period.

• Modifier - 25 can be submitted with evaluation and management services for office, ambulatory, or outpatient department services. It is used to report a significant, separately identifiable  evaluation and management service by the same physician on the same day of a service.

• Modifier -26 designates the professional component of a procedure. The acceptance of modifier -26 with a procedure is based on HCFA RBRVS. When processing modifier -26, the professional RVU is allowed.

• Modifier -50 designates the performance of a bilateral procedure. The acceptance of modifier -50 with a procedure is based on clinical consultant review.

• Modifier -51 designates the performance of multiple procedures, other than evaluation and management services, indicating an additional service or procedure has been performed.

• Modifier -54 designates Surgical care only, for use when one physician performs a surgical procedure and another provides preoperative and/or postoperative management.

• Modifier -55 designates Postoperative management only, for use when one physician performed the postoperative management and another physician performed the surgical procedure.

• Modifier -56 designates Preoperative management only, for use when one physician performed the preoperative care and evaluation and another physician performed the surgical procedure.

• Modifier 57 - is an evaluation and management service that results in the initial decision to perform surgery.

• Modifier -59 designates a distinct procedural service, other than evaluation and management services.

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