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What modifier is used to bill Medicare when a 93571 is billed. I have heard different answers and the claim keeps coming back. Thanks Nancy
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Wiki Heart Flow Reserve
- Thread starter nancy.anselmo@ccrheart.com
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This is an add-on code to a primary procedure. The only modifiers allowed by Medicare are 26 for professional component, TC for technical component, or 80 for assistant surgeon. If you are using 59 for separate procedure that is not needed since this is an add-on code. If the surgeon is providing the entire service, then no modifier should be needed, but it should be billed with the correct primary procedure.
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I billed it w/93458 and I put a 26 on it and it denied, so I was told to put the location modifier on there of RC so none of these are correct?
I agree with ajs, the only modifier you should need with this is the 26 modifier. We were putting the vessel modifier (LC,RC,LD) on these with the 26 and being denied. But once we started billing these with just the 26 modifier we started receiving payment. Hope this helps!
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Medicare denied it with the 26 modifier
It sounds like you are billing it correctly. So the only advice I can give would be to take examples of these to your Medicare Representative and see if they can help you with these denials. Sometimes this kind of instance is simply an error in the Medicare edits system. Your Medicare Rep should be able to see if this is the case. Sorry I couldn't be more help
