Blue Cross Blue Shield of North Dakota (BCBSND) has identified Current Procedural Terminology (CPT) code 90480 (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose) is rejecting as ‘included in’, when performed on the same date of service as another vaccine administration or another non-COVID vaccine code.
This is occurring due to updates Centers for Medicare & Medicaid Services (CMS) made to the National Correct Code Initiative (NCCI) Procedure-to-Procedure (PTP) Edit Files. BCBSND has updated our system to allow the use of modifiers 59, XE, XP, XS, or XU to bypass PTP edits, when appropriate, as of Oct. 17, 2025. Providers with claim rejections may submit a corrected claim to add one of these modifiers, when appropriate, to bypass the PTP edit.
CMS has provided notice that Medicare and Medicaid NCCI PTP files are being updated to no longer include PTP edits for 90480 when billed with G0008, G0009, or G0010 back to July 1, 2025. BCBSND will be adjusting claims that were rejected for the 90480 when billed with either G0008, G0009, or G0010 code combination.
Questions?
For questions, contact the phone number listed on the back of the member’s ID card or by utilizing the phone number listed on the contact us webpage.
