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Regulatory updates

Effective April 15, 2018 new Alpha/Numeric Member Identification Prefixes for all Blue Cross and Blue Shield-branded Plans – Empire Plans as well as non-Empire Plans were assigned.

Note: Current three-character, alpha-only prefixes will not be affected by this change. Current prefixes will still be valid once the new alpha-numeric prefixes are issued.

To help ensure claims are paid accurately, Empire conducts post-payment reviews of professional claims billed with Modifiers for Distinct Procedural Services (59, XE, XP, XS, and XU).

As part of these reviews, Empire may contact providers with outlying billing practices to request additional documentation related to the services. Findings may assist your office with quality improvement efforts.

Evaluation and management services that are eligible for separate reimbursement when reported by the same provider on the same day as a minor surgery, and billed with modifier 25, would be reduced by 25% beginning april 1, 2018. 

When the professional and the technical components of a global diagnostic procedure are performed separately by the same provider or associate providers in the same practice for the same patient for the same date of service, the services must be reported as a global procedure. Additionally, the service location for the global service should be reported as the location where the professional component was rendered. 

Beginning with dates of service on and after May 1, 2018, Empire will update its policy to reflect that ultrasonic guidance (CPT code 76942) will not be eligible for separate reimbursement when reported with tendon injection services represented by CPT codes 20550 (injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar 'fascia')) and 20551 (injection(s); single tendon origin/insertion). The following modifiers will not override this edit: 59, XE, XP, XS, and XU.

April 2018