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Evaluation and Management (E&M) with modifier 25 Notification

Blue Cross Blue Shield of North Dakota (BCBSND) wants to inform providers of an identified issue causing an incorrect denial of ANSI CO96 to apply on an Evaluation and Management (E&M) visit with an appropriately appended 25 modifier. This affected both Commercial and Medicaid Expansion lines of business.

This impacts claims processed between 8/2/2022 through 8/17/2022. BCBSND is working to identify claims that may have been impacted by this issue and will do an additional review. If claims are identified to be denied incorrectly, they will be adjusted accordingly.

BCBSND asks providers to continue to bill E&M services in accordance with the BCBSND Modifiers 25, 27, 59, FT, XE, XP, XS & XU reimbursement policy.
For additional questions contact the appropriate Customer Contact Center listed on the back of the members ID card or email prov.partners@bcbsnd.com.