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Reimbursement Policy Update: Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)

The contents of the reimbursement policies noted below have been consolidated within a single reimbursement policy, Distinct Procedural Service Modifiers (59, XE, XP, XS, XU).

  • Balloon Sinuplasty
  • Colonoscopy with Modifier 59
  • Hip Arthroscopy
  • Knee Arthroscopy

The consolidated policy guidelines remain consistent with the guidelines included in the prior policy versions with the exception of the following update.

Beginning November 23, 2020, we will change how we consider certain professional claims for reimbursement based on an update included within this consolidated policy content.

For services rendered on and after November 23, 2020, we will not consider the CPT® codes listed in column 1 below for separate reimbursement – even when appended with Modifier 59, XE, XP, XS or XU – when performed on the same day by the same provider as one or more corresponding codes in column 2 below.

CPT code will NOT be considered for separate reimbursement When performed with CPT code on the same day by the same provider
29823 29806, 29807, 29819, 29820, 29821, 29825
43280 43770, 43771, 43772, 43773, 43774, 43775
43281 43770, 43771, 43772, 43773, 43774, 43775
43282 43770, 43771, 43772, 43773, 43774, 43775
43283 43770, 43771, 43772, 43773, 43774, 43775
63042 22630, 22632, 22633, 22634
63047 22630, 22632, 22633, 22634
76856 93976

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after November 23, 2020.

CPT® is a registered trademark of the American Medical Association.

Published on: August 25, 2020, 09:14 a.m. ET
Last updated on: August 25, 2020, 09:37 a.m. ET