CurrentPremera BluecrossPolicy N/A

Multiple Modifiers on Professional Claims

Defines how the Plan recognizes and processes multiple claim modifiers on CMS-1500 (paper) and 837P (electronic) professional claims for Premera Blue Cross and affiliated lines of business.

Policy Summary

PayerPremera Bluecross

PolicyMultiple Modifiers on Professional Claims

Policy CodePolicy N/A

Change TypeClarification & Revision (non‑material)

Effective DateN/A

Next Review DateN/A

Key ActionAppend up to four modifiers per procedure code; if more than four apply, append modifier 99 in field 24D and place other specific modifiers in field 19 with supporting documentation.

SourceLink

POLICY UPDATE CHANGES

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

In the Policy section, added the last paragraph indicating how to code when more than four modifiers are applicable for the procedure code submitted.

up to 4modifiers accepted per code

99multi-modifier token

05/05/25last review

ASC APC exceptionASC APC exception

Modifier Handling Criteria

The Plan's stance on handling multiple modifiers on professional claims.

The Plan accepts up to four separate modifiers per procedure code.

Modifiers that affect reimbursement should be placed in the first position.

Informational modifiers (do not affect reimbursement) should be placed after reimbursement modifiers; examples include 23, 24, 25, 32, 33, 47, 57, 58, 59, 76, 77, 79, 90, 91, 92, 95, 99 and HCPCS Level II alphanumeric modifiers unless identified as reimbursement modifiers.

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

Policy Summary

PayerPremera Bluecross

PolicyMultiple Modifiers on Professional Claims

Policy CodePolicy N/A

Change TypeClarification & Revision (non‑material)

Effective DateN/A

Next Review DateN/A

Key ActionAppend up to four modifiers per procedure code; if more than four apply, append modifier 99 in field 24D and place other specific 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.

How to Submit Modifiers on Claims

Billing Rule

Modifier submission and placement

Append up to four modifiers per procedure code; place reimbursement-affecting modifiers first. When more than four modifiers are applicable, append modifier 99 (Multiple Modifiers) in field 24D of the CMS-1500 claim form and enter all other specific modifiers in field 19 (Additional Claim Information) or the equivalent electronic field. Documentation must support all modifiers.

Place modifiers that affect reimbursement in the first modifier position.
Place informational modifiers after reimbursement modifiers (examples include 23, 24, 25, 32, 33, 47, 57, 58, 59, 76, 77, 79, 90, 91, 92, 95, 99 and HCPCS Level II alphanumeric modifiers unless identified as reimbursement modifiers).
When >4 modifiers apply, append modifier 99 in field 24D and list other specific modifiers in field 19 (Additional Claim Information) or equivalent electronic field.

Modifier Types

Modifiers that affect reimbursement (place in first modifier position)

Reimbursement-affecting modifiers placementModifiers that will affect reimbursement should be placed in the first modifier position.

Examples (not exhaustive)Includes reimbursement modifiers and TC (technical component) as applicable; specific CPT/HCPCS reimbursement modifiers are placed first.

Effect on adjudicationModifiers placed first can change reimbursement; informational modifiers must follow and may still affect coverage or denial.

Modifiers that do not affect reimbursement (informational)

Informational modifiers placementOther modifiers that are only informational and do not affect reimbursement should be placed after reimbursement modifiers.

Examples listed23, 24, 25, 32, 33, 47, 57, 58, 59, 76, 77, 79, 90, 91, 92, 95, 99 and HCPCS Level II alphanumeric modifiers (unless identified as reimbursement modifiers).

Coverage impactInformational modifiers can still determine whether the service will be covered or denied.

OpenPayer

Multiple Modifiers on Professional Claims

Modifier Handling Criteria

Modifier Guidance and Limits

How to Submit Modifiers on Claims

Modifier Types