Claim editing update: Alignment with AMA CPT^® guidelines for anatomical modifiers

Effective for claims processed on or after July 1, 2025, we will update our claim editing system to align with the coding guidelines in the American Medical Association (AMA) CPT^® Manual and HCPCS Level II Manual for billing anatomical modifiers 50, RT, and LT.

According to the AMA CPT and HCPCS Level II manuals, these modifiers designate the body part on which a service is being performed. Care providers must bill claim lines according to the correct coding guidelines to ensure reimbursement eligibility. If you believe a decision on your claim reimbursement should be reviewed, follow the claims dispute process outlined in the provider manual.

If you have questions about this notification, contact your contract manager or your provider relationship management representative.