Modifier 50 Policy Facility Denial Error

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) updated their Commercial professional reimbursement policy for Multiple and Bilateral Surgery, instructing providers to begin using one (1) unit with Modifier 50, effective June 12, 2024.

The policy does not apply to facilities; however, we recently identified an editing error causing facility’s (OP and ASC) claims to deny when billed consistent with Facility Blue Book instructions (modifier 50 and 2 units).

Ambulatory Surgery Centers (ASC) contracted to file on a professional CMS-1500 claim form are encouraged to continue filing modifier 50 with two (2) units also. We’re working to resolve this issue and anticipate a correction by October. Once the error is corrected, all claims will be identified and reprocessed by Blue Cross NC. Please do not refile claims. We will provide an update when this issue has been resolved.

This communication applies to State Health Plan (SHP), Administrative Services Only (ASO), FEP, Fully Insured, and IPP Host. It does not apply to Senior Market Administration (SMA) or IPP Home claims.