Blue Cross and Blue Shield Coding Provisions in Effect

Several coding provisions of the Blue Cross and Blue Shield settlement agreement, which provide for greater transparency in claims processing and payment practices, took effect Jan. 21. Under the agreement, Blues plans are required to follow guidelines, conventions and Current Procedural Terminology (CPT), which include:

  • Recognition of CPT-designated "add-on" codes, CPT modifiers 25 and 59, and CPT supervision and interpretation codes;
  • Ensuring no global period for surgical procedures will be longer than the period designated by the Centers for Medicare & Medicaid Services;
  • Blues parties not automatically changing a CPT code to one reflecting a reduced intensity of service.

For additional provisions, visit the American Medical Association's Health Insurer Settlements Web page.


TMA Practice E-tips main page  

Last Updated On

March 30, 2017