Blue Cross and Blue Shield of Texas (BCBSTX) regularly evaluates the coding practices of physicians and other providers who submit claims for services. This includes issues such as bundling and use of CPT modifiers. 

BCBSTX recently studied use of Modifier 59 (Distinct procedural service) with submission of CPT 99000 (Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory).  Because CPT 99000 is purely an administrative service and not a procedure, BCBSTX considers use of Modifier 59 for this code to be inappropriate.  This inappropriate use of Modifier 59 results in override of a claim system edit that considers CPT 99000 incidental to any other service performed on that date of service, including CPT 36415 for routine collection of venous blood, and results in an overpayment.  Please do not submit claims for CPT 99000 with Modifier 59.

posted 6/2009