Duplicate Reporting of Diagnostic Services – professional
December 30, 2015BCBS Georgia has updated their policy as of December 1, 2015 to document their current edit that when one provider reports a global procedure and a different provider reports the same procedure with a professional (26) or technical (TC) component modifier for the same patient on the same date of service, the first charge approved by BCBSGa will be eligible for reimbursement and subsequent charges processed will be considered duplicate services and will not be eligible for separate reimbursement. Beginning with claims processed on or after March 1, 2016, If a global procedure is billed without a –26 or – TC present in any modifier fields, and the place of service (POS) is Inpatient or Outpatient, the professional component (–26) will be assumed on the current line. If either -TC or -26 have been paid in history, and a global component is reported (either a current claim line reported with both modifiers – TC and – 26, or a claim line reported without any modifiers and a POS not inpatient or outpatient) on the current claim line, the global component will be denied. It should also be noted that duplicate submissions for the total global procedure or its components across different providers will be denied.