BCBS – National Correct Coding Initiative (NCCI) Processing Update – Professional Claims Only

The Centers for Medicare & Medicaid (CMS) issued Change Request (CR) 11168, effective July 1, 2019. The CR indicating providers will be allowed to append modifiers 59, XE, XS, XP, and XU to the NCCI column one or column two code pairs. Prior to this change, CMS required modifiers 59, XE, XS, XP, and XU to be appended to the column two code only and would not allow reimbursement on the column two code when the modifier was appended to the column one code.
 Blue Cross Blue Shield of North Dakota (BCBSND) has adopted this change and will allow the use of modifier 59, XE, XS, XP, and XU on both the NCCI column one or column two codes. We would like to remind providers the use of modifiers 59, XE, XS, XP, and XU are only applicable when the NCCI modifier indicator is “1”, which allows the use of one of these modifiers.  When the NCCI modifier indicator is “0” or “9” the addition of modifiers 59, XE, XS, XP, and XU would not be appropriate.

Source: https://www.bcbsndhealthcarenews.com/?issue_number=409-jul2019