BCBS FL Limited Code Combinations

The following is a list of combinations that Blue Cross and Blue Shield of Florida has determined are not appropriately reported together with modifier 59 and which differ from American Medical Association (AMA) Current Procedural Terminology (CPT) coding guidelines:

• Any code defined as a “B” Status code on the CMS Medicare Physician Fee Schedule appended with modifier 59 will not be reimbursed separately when submitted with any other code.

• Any code that does not allow an override of National Correct Coding Initiative edit (NCCI) as published by CMS when appended with modifier 59, will not be reimbursed separately.

• 36591 when appended with modifier 59 will not be reimbursed separately when submitted with any other code

• 36592 when appended with modifier 59 will not be reimbursed separately when submitted with any other code

• 63047 and 63048 when appended with modifier 59 will not be reimbursed separately when submitted with codes 22630 and 22632.

• 76376 when appended with modifier 59 will not be reimbursed separately when submitted with any other code

• 76377 when appended with modifier 59 will not be reimbursed separately when submitted with any other code

• 94760 when appended with modifier 59 will not be reimbursed separately when submitted with any other code.

• 96523 when appended with modifier 59 will not be reimbursed separately when submitted with any other code

• G0101 and G0102 when appended with modifier 59 will not be reimbursed separately when submitted with codes 99381-99397.

• Q0091 when appended with modifier 59 will not be reimbursed separately when submitted with codes 99384-99387 and 99394-99397.

• Q0092 when appended with modifier 59 will not be reimbursed separately when submitted with any other code

• R0070 when appended with modifier 59 will not be reimbursed separately when submitted with any other code

• R0075 when appended with modifier 59 will not be reimbursed separately when submitted with any other code

The following is a list of combinations that Blue Cross and Blue Shield of Florida has determined are not appropriately reported together with modifier 25 and which differ from American Medical Association (AMA) Current Procedural Terminology (CPT) coding guidelines:

• 99211 when appended with modifier 25 will not be reimbursed separately when submitted with procedure codes 96360-96376 and 96401-96425.

Reference: http://www.bcbsfl.com/DocumentLibrary/Providers/Content/LimitedCodeCombinations.pdf

Also see BCBS Bundling edits

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