Name of Manual - Blue Cross and Blue Shield of Minnesota

Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (10/05/11)
Coding Policies and Guidelines (Modifiers)
MOD Description Submission Guidelines Impact to Payment
-25 Significant
Separately
Identifiable
Evaluation and
Management
(E/M) Service by
the Same
Physician on the
Same Day of the
Procedure or
Other Service
-26 Professional
Component
-50 Bilateral
Procedure
Use the –25 modifier when an E/M service
is rendered on the same day as a minor
surgical procedure (0 or 10 day global
period).
The use of –25 is appropriate only when
the E/M service provided is above and
beyond the usual pre and post-operative
service associated with a procedure.
No documentation needs to be submitted
with the initial claim. However, E/M
services submitted with a –25 modifier are
subject to review. Furthermore, medical
documentation, when requested, needs to
support the significant, separately
identifiable E/M service.
Note: Requests to add a modifier -25 to a
denied service must follow the
replacement claim process. An
adjustment request will not be
allowed.
Certain procedures are a combination of a
physician component and a technical
component. When the physician
component is reported separately, the
service may be identified by adding the
modifier ‘26’ to the usual procedure
number.
The professional component applies to the
physician who interprets the procedure and
provides a written report.
Surgical procedures performed on bilateral
pieces of anatomy should be billed on one
line. The –50 modifier should be appended
to the submitted lines of service.
Blue Cross adheres to CMS’ published list
of bilateral procedures
Separate payment of
the E/M may be
allowed.
Payment is made
based on the
professional portion
of the RVU
associated with the
service.
Payment is made at
150% of the allowed
amount for the
procedure.
11-5