How to submit BCN, Medicare Plus Blue and BCN Advantage skin biopsy claims for payment

Procedure code *11102 is related to biopsy procedures on the skin. As of October 2023,  we pay Medicare Plus Blue℠, BCN Advantage℠ and Blue Care Network claims for this procedure code if the following statements apply:

• Procedure code *11102 is reported with other integumentary codes.
• Modifier 59 and related XE, XS, XP and XU modifiers are appended on the claims.

Reminder: Health care providers should continue following the guidelines communicated in our September 2021 article. This applies to appending modifier 59 and related XE, XS, XP and XU modifiers.

We no longer automatically pay for certain procedures that are billed with modifier 59 and related XE, XS, XP and XU modifiers, when they’re billed with a procedure code on the Centers for Medicare & Medicaid Services’ National Correct Coding Initiative Procedure-to-Procedure list.

Only select codes allow modifier 59 and related XE, XS, XP and XU modifiers to automatically bypass the National Council on Compensation Insurance code-pair edits.

The additional review assures that claims have been coded correctly for more complex situations where an overriding modifier has been appended.

Providers should:

• Code claims to the level of specificity for the services rendered.
• Appropriately append diagnosis codes and modifiers following the guidelines published by the American Medical Association and CMS.

The reported services should be supported in the patient’s medical record.

Note: Claims can be resubmitted for payment.