New coding guidelines: include the anatomic modifier

For claims processed on or after April 1, 2025, our claim editing system will align with the AMA CPT^® Manual and HCPCS Level II Manual correct coding guidelines for billing anatomical modifiers 50, RT, and LT.

According to the AMA CPT and HCPCS Level II manuals, the appropriate anatomical modifier must be appended to the appropriate procedure code. These modifiers designate the area or part of the body on which a service is being performed.

If you believe a claim reimbursement decision should be reviewed, please follow the claims dispute process outlined in the Provider Manual.

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