MODIFIERS – Professional Claims
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 1 MODIFIERS Professional Claims Effective 8/27/07 Blue Cross and Blue Shield of Texas/HMO Blue Texas accept all valid CPT and HCPCS MODIFIERS into the Claims processing systems. The following MODIFIERS have logic associated with them that might impact the claim . ________________________________________ ____________________________ Modifier 22: Denotes an unusual procedural service. Should only be submitted on surgical procedure codes along with supporting documentation to justify the unusual service: 9 If documentation supports sufficient difficulty/complexity to warrant additional payment for a procedure submitted with Modifier -22, then 25% of the eligible amount is allowed as an additional payment.
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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