04/20/2023

Empire BCBS Denials for Modifier Usage for CPT 28296

Empire Health choice Blue Cross Blue Shield has been denying 28296 Austin Bunionectomy as missing/invalid procedure codes. All other insurances have been paying. Please advise

The surgery was denied correctly by Blue Cross for an improper modifier. When billing a bunionectomy, a -T modifier must be billed with the surgical procedure. This would apply if this was for the primary or assistant surgeon. A corrected claim with the appropriate-T modifier based on the op-reports should reverse the denial from the insurance.