Please note which type of providers will be affected by each reimbursement policy for specific modifiers and the effective date it begins.
The following reimbursement updates take effect as of July 1, 2022:
- Modifier 52- for services performed on 07/01/2022 and thereafter, Blue Cross will be begin reimbursing procedure codes billed with a -52 modifier at the lesser of 50% of the physician fee schedule allowance or charge submitted for the following lines of business: • Commercial• Federal Employee Program (FEP)
- The Reimbursement Policy, General Coding – 003 Coding Edits will be updated to reflect this change.
PT/OT/ST services reimbursement with modifiers CO, CQ for DOS 07/01/2022 and thereafter:
- Commercial plans-
Blue Cross will be implementing a 15% reduction in the allowed amount for services
modified with CO or CQ modifier for professional providers.
The following reimbursement Policy took affect for DOS 01/01/2022 and thereafter
1. Medicare Advantage Plans-
Blue Cross implemented a 15% reduction in the allowed amount for services modified with CO or CQ modifier for professional and facility providers to comply with requirements of the Centers for Medicare & Medicaid Services (CMS).
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