July 9, 2026
The following policies received their annual review with no changes:
The following policies received their annual review with the changes noted below:
Claim editing
- Removed BlueCard Home claims from policy section stating what claim types/claim categories the edits do not apply to.
Modifier 22
- Clarified documentation review statement in Policy section.
Modifier 58
- Changed the title from “Modifier 58 - Staged or Related Procedure or Service by Same Physician or Other Qualified Healthcare Professional during Postoperative Period” to “Modifiers 58, 78, and 79 - Related, Staged, and unrelated procedures.”
- Added policy criteria from modifier 78 and modifier 79 policies as these policies are archived effective July 9, 2026.
Modifier 62
- In the policy section, added modifier 66 details: “If three or more surgeons are required to perform a highly complex procedure, each surgeon must report modifier 66 to indicate services performed as part of a surgical team.”
- Added exceptions statement: “In the event of a conflict between CMS guidelines and AMA/CPT guidelines for modifier 62, the Plan will follow the guidelines established by the AMA/CPT.”
Intraoperative Neurophysiologic Monitoring (IONM) Billing
- Added reference: AMA CPT Knowledge Base, September 24, 2020, Medicine, Neurology and Neuromuscular Procedures
- Revised third paragraph for clarification around separate reimbursement for “Incident to” services.
New and Established Patient Guidelines
- In the Policy section, added clarifying details for specialty/subspecialty and tax identification (TIN).
Preadmission Testing
- Changed policy title from “Preadmission Testing” to “Preadmission Services.”
- In definitions section, changed “Preadmission Testing” to “Preadmission Services.”
- In Exceptions section, clarified Mother/Baby claims to include diagnosis related ranges
The following policies will be archived
Modifier KX
- This policy is archived effective July 9, 2026.
Modifier 78
- This policy is archived effective July 9, 2026. Please refer to the Modifier 58, 78, 79 Payment Policy.
Modifier 79
- This policy is archived effective July 9, 2026. Please refer to the Modifier 58, 78, 79 Payment Policy.
Prolonged Services for Labor Management
- In the policy section, added “This policy will be archived effective for dates of service on or after January 1, 2027. Revised coding section to clarify code time reporting details.”