Modifer 22 Submission Tips
Effective as of August 23, 2010, all surgical claims submitted with modifier 22 and with the operative report are up-front reviewed by BCBSTX. If the operative report is included with the claim, the claim is sent to our Medical Review Unit for review and determination if additional reimbursement is warranted. If the operative report is not included, the claim is adjudicated at the contracted rate and reconsidered if submitted as an inquiry with the operative report.
To accommodate electronic claim submissions, you can fax the operative report to one of the following numbers listed below within 72 hours of submitting your claims:
The following information must be included on the coversheet to ensure the operative report is routed to the appropriate processing area:
- Claim Number
- Group Number
- Subscriber Number (Including Alpha Prefix)
- A note stating the following:
"This is additional information for the claim referenced that was submitted on (date) for (Patient's Name)"