04/04/2023

BCBS Denials for Modifier Usage for CPT 28296

Blue Cross and Blue Shield has been denying claims without an explanation on their website or portal regarding the usage of modifiers when we bill 28296. Attached is a copy of the EOB with the denial. 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.