BCBS covered modifier – when to use

by | Jul 28, 2010 | CPT modifiers

When a Modifier may be covered – BCBS of  North Carolina

• Modifiers -62 and -66 designate services performed by two surgeons or a surgical team, and will be reviewed on an individual consideration basis.

• Modifiers -80, -81, and -82 designate assistant surgeon services. Blue Cross and Blue Shield of North Carolina uses ClaimCheck® as its primary source for determining those procedures available for assistant surgeon benefits. The assistant surgeon classifications assume that the assistant surgeon is boardcertified or otherwise highly qualified as a skilled surgeon. Automatic edits are performed on assistant surgeon claims to determine if any procedures have been inappropriately billed by a surgical assistant. If guidelines are not met, the claim will suspend.

• Modifier -AS designates that services were provided by a physician assistant, nurse practitioner or nurse midwife for an assistant at surgery. Blue Cross and Blue Shield of North Carolina uses Claim Check as its primary source for determining those procedures available for assistant surgeon billing by physician assistants, nurse practitioner or nurse midwife. Automatic edits are performed to determine if any procedures have been inappropriately billed by the physician assistant, nurse practitioner or nurse midwife.

• HCPCS site-specific modifiers E1-E4 (eyelids), FA-F9 (fingers), TA-T9 (toes), -RT (right), -LT (left), and -LC, -LD, and -RC (coronary vessels), are helpful in determining claims payment when multiple surgical procedures are performed on different anatomical sites during the same operative session.

• Modifier GT – Via interactive audio and video telecommunication systems will be allowed with code 99201 – 99205, 99212 – 99215(Office or Other Outpatient Services) and 99241 – 99245 (Office or Other Outpatient Consultations).

• Modifier – MS a six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty.

• Modifier – RP Replacement and repair may be used to indicate replacement of DME, orthotic and prosthetic devices which have been used for sometime.

• Modifier -TC designates technical component services were provided and will be allowed at a reduced rate in comparison to the allowance for the full service.