Modifier 26 no longer used to support denial of new patient claim

On Oct. 10, 2022, a Blue Cross Blue Shield of Michigan payment policy was updated so that procedure codes previously submitted with a modifier 26 aren’t used to support the denial of a new patient visit. Providers are allowed to bill a new patient visit when the only previous patient encounters that they have billed were billed with a modifier 26, indicating that only the professional component of a procedure was performed.

If you have submitted a new patient office visit and received a denial based on a previous patient encounter billed with a modifier 26, you can resubmit your claim for consideration.