Does BCBS insurance follows Medicare NCCI edits
Yes, BCBS follows Medicare NCCI edits and the same has been incorporated into BCBS editing system. BCBS considers CMS NCCI edits are a recognized industry source for relationships between codes. All BCBS code editing systems will be incorporated with Medicare NCCI edits but the implementation dates differs between the states. For example Effective October 23, 2008, all Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) edits has been incorporated into Blue Cross Blue Shield of Florida’s (BCBSF) code editing system whereas Blue cross of Alabama began using National Correct Coding Initiative edits effective October 1, 2010.
BCBS will use the “Column One/Column Two” NCCI edits to determine whether CPT and/or HCPCS codes reported together by the same physician for the same member on the same date of service are eligible for separate reimbursement. There are specific modifiers that may be appended to CMS’ NCCI Columns 1 and 2 edits and Mutually Exclusive edits as well as BCBS edits when appropriate.
References:
www.bcbsfl.com/DocumentLibrary/Providers/Content/227095.pdf
https://www.bcbsal.org/providers/newpaymentmethodology/modifiers.pdf
https://www.excellusbcbs.com/wps/wcm/connect/b75fc7804533079db35cfbef58edd5a7/Jan11ConnectionFinalWeb.pdf?MOD=AJPERES
http://www.bcbst.com/providers/bluecare-tenncareselect/
Popular Posts
-
Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...
-
Therapeutic activities are considered medically necessary for patients needing a broad range of rehabilitative techniques that involve ...
-
Urgent Care Centers are the Facilities that delivers Outpatient Medical Care usually for the conditions that does not require Hospital a...
-
Ambulance transportation is a covered service when the patient’s condition is such that the use of any other method of transportation would...
-
Modifier -26 identifies the physician's or professional component of a two-component (professional and technical) service. The physicia...
-
Definition: The “-59” modifier is used to indicate a distinct procedural service. The physician may need to indicate that a procedure or...
-
Chiropractic is a form of alternative medicine that emphasizes diagnosis, treatment, and prevention of mechanical disorders of the musculos...
-
Myocardial perfusion imaging is being done to determine the significance or the extent of myocardial ischemia (or scar), or to assess my...
-
Sentinel lymph node identification and biopsy typically involves a multidisciplinary approach. A nuclear medicine procedure called lymph...
-
Modifier 51 designates multiple procedures that are rendered at the same operative session or on the same day. Modifier -51 (multiple p...
Posts
