Tag: #Medicareadvantage

Please note which type of providers will be affected by each reimbursement policy for specific modifiers and the effective date it begins.

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The following reimbursement updates take effect as of July 1, 2022:

1. 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)
2. The Reimbursement Policy, General Coding – 003 Coding Edits will be updated to reflect this change.

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PT/OT/ST services reimbursement with modifiers CO, CQ for DOS 07/01/2022 and thereafter:

1. 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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