Blue Cross retires modifier 22 payment policy for pain control optimization pathway program

Blue Cross Blue Shield of Michigan’s pain-control optimization pathway, or POP — and an associated modifier 22 payment mechanism — will end Dec. 31, 2021. Part of a pilot program, it’s being retired due to the success of the initiative.

Blue Cross’ pilot program was introduced nearly three years ago to assist providers with appropriate pain management following certain surgical procedures, including limited post-operative opioid dispensing to help reduce risks associated with dependence and diversion. The initiative covered 20 surgical procedures aimed at promoting effective pain control through care processes that limit opioid dispensing.

The pain-control optimization process is an evidence-based prescribing pathway created by surgeons in partnership with Michigan Opioid Prescribing Engagement Network, or Michigan-OPEN, to address opioid overprescribing following surgery. The POP program and use of modifier 22 were both instrumental in reducing opioid prescribing patterns over the course of the initiative while still providing appropriate pain management.

Modifier 22 will continue to be used for other purposes.