11/30/2023

BCBS Healthplus Mediblue Dual Denials for CPT 20551 with Modifier 50

We have multiple denials from BCBS Healthplus Mediblue Dual for procedure code 20551 billed with a 50 modifier. The denial reason is stating "The procedure code is inconsistent with the modifier used or a required modifier is missing. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present." The only additional information the reps give us when calling is to refer to CMS policy. This code is billed to Medicare and payment is made. What do we do at this point?

A corrected claim needs to be rebilled to Blue Cross to address the denial for the injections. Each side should be billed as one unit of service for a total of 2-line items. There should be a -LT & -RT modifier listed on each injection. Edits with Anthem Blue Cross are set to pay some procedures bilaterally, while others need to have the modifiers specified for the left & right side.