Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Surgical Services)
General Guidelines Generally, Blue Cross covers only surgical procedures performed
by a physician for the treatment of illness or injury.
Follow these procedures to bill surgical charges:
Submit each surgical procedure on a separate line.
Surgical units:
Most surgical procedures should be submitted only with one
unit; however, we can accept more than one unit for those
surgical procedure codes whose narrative includes a unit
indicator, such as “each” or “per.” For example, 11201 is an
add-on code to 11200. Code 11201 indicates “each additional
10 lesions.” If 35 skin tags are removed, code 11200 would be
reported with one unit for the first 15 lesions. Code 11201
could be reported with two units for the additional 20 skin tags.
Submit all surgeries performed on the same date on one claim.
List the appropriate procedure code for each one.
Modifier -51 may be used for secondary procedures but is not
required.
Bilateral Services The bilateral modifier –50 is used to indicate cases in which a
procedure normally performed on only one side of the body is
performed on both sides. The CPT descriptors for some procedures
specify that the procedure is bilateral. In such cases, the bilateral
modifier should not be used. Blue Cross requires submission of
one line for bilateral procedures. Correctly submitted services will
be eligible for 150 percent of the procedure allowed amount.
11-2
Certain edits apply to bilateral services:
If a CPT defined bilateral procedure is submitted with a -50
modifier, the service will be denied based on submission of an
incorrect procedure/modifier combination.
If more than one line of the same procedure code is submitted
– one with the -50 modifier and one without – the unmodified
line(s) will be denied as duplicative.
Bilateral services on claims resubmitted will need to be
submitted using the one-line reporting method regardless of the
date of service.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (03/19/12)