Wiki 52 modifier denial on claim from medicare

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surfergirl

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Good Morning,
I received a denial on 2 claims 2 separate patients that modifier 52 was added due to my physician not being able to complete these procedures.

the Denial code was 16 saying claim lack service information.

Are they looking for the op report?

Appreciate the Education
 
It's possible they will require the operative report, but a CO-16 denial is more of a rejection than a denial and usually means there is something wrong with the claim submission that prevents Medicare from processing, so just sending the report or appealing is probably not going to solve this. There should be an additional RARC code on the EOB to explain what caused the rejection (code usually starting with the letter M or N) which will tell you what needs to be corrected. If that code is not on the EOB, then you probably will need to contact your Medicare contractor to get an explanation.
 
thomas7331 said:
It's possible they will require the operative report, but a CO-16 denial is more of a rejection than a denial and usually means there is something wrong with the claim submission that prevents Medicare from processing, so just sending the report or appealing is probably not going to solve this. There should be an additional RARC code on the EOB to explain what caused the rejection (code usually starting with the letter M or N) which will tell you what needs to be corrected. If that code is not on the EOB, then you probably will need to contact your Medicare contractor to get an explanation.
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Thank you!
 
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