CurrentPremera BluecrossPolicy N/A

Multiple modifiers billing and reimbursement

Defines when the Plan recognizes and reimburses professional services billed with multiple claim modifiers on CMS-1500/837P professional claims; applies to Premera Blue Cross lines of business and affiliated products and excludes providers reimbursed under ASC APC methodology.

Policy Summary

PayerPremera Bluecross

PolicyMultiple modifiers billing and reimbursement

Policy CodePolicy N/A

Change TypeAdded operational claim instructionsadded reimbursement modifiers

Effective DateN/A

Next Review DateN/A

Key ActionIf more than four modifiers apply, append modifier 99 in field 24D and list other modifiers in field 19 with supporting documentation.

SourceLink

POLICY UPDATE CHANGES

When more than four modifiers are applicable, modifier 99 (Multiple Modifiers) should be appended to the procedure code and other specific modifiers placed in field 19 or the equivalent electronic field.

Reimbursement modifiers CO, CQ, and QZ were added to the list of modifiers that affect reimbursement.

Clarified that the policy applies to professional services billed on a CMS-1500 or 837P claim form.

up to fourmodifiers accepted per code

99multiple-modifier token

3new reimbursement modifiers

CMS-1500/837Pgoverning claim forms

ASC APCexcluded methodology

Modifier Acceptance and Placement

Modifier acceptance and placement criteria

Covered when ALL of the following are met:

The Plan accepts up to four separate modifiers per procedure code; reimbursement modifiers should be placed in the first position on the claim.

Informational modifiers should be placed after reimbursement modifiers and may determine whether the service is covered or denied.

When more than four modifiers apply, append modifier 99 (Multiple Modifiers) to the procedure code in field 24D of the CMS-1500 (or equivalent electronic field) and list all other specific modifiers in field 19 (Additional Claim Information) or the equivalent electronic field; documentation must support all modifiers appended.

This policy applies to professional services submitted on CMS-1500/837P professional claim forms and does not apply to providers reimbursed under an ASC APC payment methodology.

Modifier Categories and Limits

Policy Summary

PayerPremera Bluecross

PolicyMultiple modifiers billing and reimbursement

Policy CodePolicy N/A

Change TypeAdded operational claim instructionsadded reimbursement modifiers

Effective DateN/A

Next Review DateN/A

Key ActionIf more than four modifiers apply, append modifier 99 in field 24D and list other modifiers in field 19 with supporting documentation.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Claim Submission Steps and Billing Rules

Billing Rule

Submit >4 Modifiers: Use modifier 99 in 24D and list specifics in field 19

When more than four modifiers apply to a procedure code, append modifier 99 (Multiple Modifiers) to the procedure code in field 24D of the CMS-1500 (or the equivalent electronic field). Enter all other applicable specific modifiers into field 19 (Additional Claim Information) on the CMS-1500 (or the equivalent electronic field). Documentation must support all modifiers appended.

Append modifier 99 to the procedure code in field 24D (CMS-1500) or equivalent electronic field.
List all other specific modifiers in field 19 (Additional Claim Information) or equivalent electronic field.
Maintain documentation that supports all modifiers appended to the claim.

Modifier Definitions and Ordering

Modifiers that affect reimbursement

Actionable placement ruleReimbursement modifiers should be placed in the first position on the claim

Examples of reimbursement modifiers (not limited to)22, 26, 50, 52, 53, 54, 55, 56, 62, 73, 78, 80, 81, 82, AD, AS, CO, CQ, QK, QX, QY, QZ, TC

Scope noteThese modifiers affect reimbursement and therefore must precede informational modifiers on professional claims (CMS-1500 / 837P)

Informational modifiers

Placement rule for informational modifiersInformational modifiers should be placed after any modifiers which affect reimbursement

Examples of informational modifiers (not limited to)23, 24, 25, 32, 33, 47, 57, 58, 59, 76, 77, 79, 90, 91, 92, 95, 99, HCPCS Level II alphanumeric modifiers

Potential impactInformational modifiers do not affect reimbursement but can determine whether the service is covered or denied

22	Increased procedural services
26	Professional component
50	Bilateral procedure
52	Reduced services
53	Discontinued procedure
54	Surgical care only
55	Postoperative management only
56	Preoperative management only
62	Two surgeons
73	Discontinued outpatient hospital/ambulatory surgery prior to anesthesia